Alcohol

Question 1

What are the functions of the liver?

Answer 1

Carbohydrate metabolism
Fat metabolism
Protein metabolism
Storage
Synthesis
Produce bile
Metabolism of drugs and alcohol
Filtration of blood

Question 2

How is alcohol processed in the liver?

Answer 2

Alcohol –> acetylaldehyde –> acetate –> fatty acids, CO2 and H2O

Question 3

What enzymes are involved in breaking down alcohol in the liver?

Answer 3

ADH

ALDH

Question 4

What is the issue with alcohol being broken down to acetylaldehyde?

Answer 4

Carcinogenic

Question 5

How long does it take to process a unit of alcohol?

Answer 5

Healthy liver= 1 hour

Question 6

What are the risk factors for liver disease?

Answer 6

Poor dietary status
Simultaneous exposure to other drugs
Genetic variations/polymorphisms
Female
Coexisting viruses

Question 7

What are indicators of chronic alcohol use?

Answer 7

Elevated gamma GT
Macrocytosis
Low platelets
Elevated ferritin
Enlarged smooth edged liver on US

Question 8

What are the stages of progression of liver disease?

Answer 8

Normal –> steatosis –> statohepatitis–> fibrosis –> cirrhosis

Question 9

Wha is alcoholic hepatitis?

Answer 9

Fatty change in liver

Hepatic necrposis and infiltration with leucocytes

Question 10

What are the signs and symptoms of alcoholic hepatitis?

Answer 10

Hepatomegaly
Jaundice
Abdo pain
Fever
Heoatic decompensation

Question 11

What is used to determine severity of alcoholic hepatitis?

Answer 11

Glasgow alcoholic hepatitis score

Question 12

What is the treatment of alcoholic hepatitis?

Answer 12

Abstinence
Steroids
Management of infection
Nutrition

Question 13

What is the pathology of fibrosis and cirrhosis of the liver?

Answer 13

Chronic inflammation
Collagen bridging between veins and tracts
Loss of lobule structure
Activation of stellate cells

Question 14

What are the complications of cirrhosis?

Answer 14

Variceal haemorrhage
Encephalopathy
Ascites

Question 15

What is the treatment of cirrhosis?

Answer 15

Abstinence

Question 16

What is the diagnostic criteria for alcohol dependence?

Answer 16

3 or more of the following for >1 month or repeatedly over 12 months

• craving/compulsions
• difficulty controlling use
• primacy
• increased tolerance
• physiological withdrawal
• persistance despite harmful consequences

Question 17

What is the CAGE screening tool?

Answer 17

Have you ever...
felt the need to Cut down?
felt Annoyed by your drinking being criticised?
felt Guilty about drinking?
felt the need for an Eye opener?

Question 18

What is the management of alcohol dependence?

Answer 18

Support
Social work
Psychiatry
Inpatient care
Medication

Question 19

What is the withdrawal state?

Answer 19

Group of symptoms of variable clustering and severity on complete/relative withdrawal of a psychoactive substance, after persistent use of that substance

Question 20

What are the signs and symptoms of alcohol withdrawal?

Answer 20

Tremor
Weakness
N&V
Anxiety
Seizures
Confusion
Agitation
Death
Delirium tremens

Question 21

What are the features of delirium tremens?

Answer 21

Profound confusion, tremor, agitation, hallucinations, delusions, sleeplessness, autonomic overactivity

Question 22

When does delirium tremens occur?

Answer 22

48-72 hours after alcohol stopped

Question 23

What causes death is delirium tremens?

Answer 23

CV collapse
Infection
Hyperthermia
Seizures
Self injury

Question 24

What is the treatment of alcohol withdrawal?

Answer 24

Benzodiazepines- esp chlordiazepoxide
Prevention of Wernicke-Korsakoff syndrome- thiamine
Deterrent- disulfiram
Anti-craving- acamprosate, naltrexone, nalmefene

Question 25

What are the consequnces of alcohol problems?

Answer 25

health (liver)
Relationships (lover)
Livelihood
Law

Question 26

What physical problems can alcohol cause?

Answer 26

Cancer- mouth, oesophagus, stomach, liver
Cerebral trophy
Wernicke's encephalopathy
Korsakoff's psychosis
Cirrhosis