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Year 3 > Alcohol > Flashcards

Alcohol Flashcards

1
Q

functions of the liver

A

• Carbohydrate metabolism
o Excess glucose – glycogenesis (storage)
o Low blood glucose – glycogenolysis to provide more
• Fat metabolism
o Lipid metabolism predominantly within the liver
o Breaks down fats to produce phospholipids and cholesterol
• Protein metabolism
o Deamination and transamination of AAs
o Byproduct is ammonia – liver synthesises urea to remove
o Albumin synthesis (main protein of blood plasma) almost exclusive to the liver
• Storage
o Glucose, iron, copper, vitamins
• Synthesis
o Fibrinogen (to fibrin)
o Thrombopoietin (platelet production in bone marrow)
• Kupffer cells – rubbish collectors (bacteria, old cells etc)
• Production of bile – allows fat breakdown in small intestine
• Metabolism of drugs and alcohol

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2
Q

discuss liver processing of alcohol

A
  • Consumption of alcohol
  • Absorption into blood from mouth, oesophagus, stomach and intestines
  • Blood arrives at liver
  • Alcohol à acetaldehyde à acetate
  • Enzymes ADH and ALDH
  • Acetate converted to fatty acids, C20 andH20
  • Healthy liver processes 1 unit of alcohol per hour
  • Acetaldehyde is a carcinogen
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3
Q

how much alcohol is too much?

A
  • <14 units per week
  • M=F
  • Keep health risks at a low level
  • Regular consumption – spread over > 3 days
  • > 100 units per week 20% develop serious liver disease
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4
Q

How Can Some People Drink More Without Damaging their Liver?

A

• Poor dietary status – nutritional deficiencies
• Simultaneous exposure to other drugs (affects metabolism)
• Genetic variations/polymorphisms of enzymes
o Fast acting ADH or slow acting ALDH (build-up of acetaldehyde)
o Dependence and progression
• Females more vulnerable
• Coexisting viruses e.g. Hep C

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5
Q

discuss steatosis

A
  • Alcohol à acetaldehyde à acetate à fatty acids
  • Alcohol is calorie rich
  • Fat deposition around central veins then parenchyma
  • Abstain from alcohol – liver returns to normal
  • Reversible
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6
Q

indicators of chronic alcohol use

A
  • Elevated GGT
  • Macrocytosis
  • Low platelets
  • Elevated ferritin
  • Enlarged smooth edged liver on USS
  • History
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7
Q

discuss alcohol hepatitis

A 
• Fatty change within the liver
• And
o Infiltration with leucocytes
o Hepatic necrosis
• Results in
o Hepatomegaly
o Jaundice
o Abdominal pain
o Fever
o Hepatic decompensation
• May or may not be cirrhotic
• Glasgow Alcoholic Hepatitis Score (28 day survival)
o Day 1 GAHS < 9 87%
o > 9 46%
o Age, markers of inflammation and liver function
• Steroids, management of infection and nutrition
• Renal impairment and coagulopathy
• Abstinence
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8
Q

discuss liver fibrosis

A
  • Chronic inflammation
  • Activation of stellate cells
  • Collagen production
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9
Q

discuss cirrhosis

A

• Localised fibrosis around vein
Figure 1 Structure of the Liver
• Collagen bridging between veins/tracts
• Loss of lobule structure

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10
Q

complications of cirrhosis

A
  • Variceal haemorrhage
  • Encephalopathy
  • Ascites
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11
Q

discuss the effects of abstinence on liver disease

A

• Decompensated cirrhosis
o 5 year survival if abstinent 65%
o 5 year survival if ongoing alcohol consumption 35%
• Liver breaks down the majority of alcohol
• Overload breakdown process leads to build up of toxic metabolites
• Alcohol related liver disease is a spectrum of illness
• Early stage is reversible
• Cofactors influence disease progression
• Abstinence always improves prognosis

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12
Q

low dose effects of alcohol

A

euphoria, reduced anxiety, relaxation and sociability

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13
Q

high dose effects of alcohol

A

intoxication which is the pathological state produced by a drug, serum, alcohol, or any toxic substance
i.e. poisoning. Intoxication causes impaired attention and judgement, unsteadiness, flushing,
nystagmus, mood instability, disinhibition, slurring, stupor and unconsciousness.

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14
Q

what is alcoholism?

A

Harmful use is a pattern of use causing damage to physical or mental health. Use >1 month or
repeatedly over 12 months.

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15
Q

define alcohol dependence

A

Dependence is having 3 or more of the following for > 1 month or repeatedly over 12 months:
• Cravings/compulsions to take
• Difficulty controlling use
• Primacy
• Increased tolerance
• Physiological withdrawal on reduction/cessation
• Persistence despite harmful consequences

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16
Q

symptoms of alcohol withdrawal

A
  • Tremor
  • Weakness
  • Nausea
  • Vomiting
  • Anxiety
  • Seizures
  • Confusion
  • Agitation
  • Death
17
Q

what is delirium tremens?

A

Delirium tremens is profound confusion, tremor, agitation, hallucinations, delusions, sleeplessness,
autonomic over-activity. There is a 5% mortality with DTs. Death occurs as a result of cardiovascular
collapse, infection, hyperthermia, seizures or self-injury. DT is most likely to develop 48-72 hours after
alcohol is stopped.

18
Q

alcohol can cause problems in what domains?

A

physical and mental health, relationships, employment, finances,
and legal difficulties. Liver, Love, Livelihood, Legal

19
Q

mental health effects of alcohol

A
  • Anxiety
  • Depression
  • Sleep disturbance
  • Morbid jealousy – Othello Syndrome
  • Alcoholic hallucinosis
  • Deliberate self-injury
  • Suicidal thoughts/acts
20
Q

how long after abstinence may it take for mental SEs to dissolve?

A

3 months

21
Q

physical health effects of alcohol

A

accidental injury, violence, cancer of the mouth, oesophagus and liver, neurological – fits,
confusion, Korsakoff’s/Wernicke’s.

22
Q

what is wenicke’s encephalopathy?

A

state of confusion, ataxia, ophthalmoplegia and nystagmus. Only 15%
have the triad of symptoms, but if you have identified risk then must treat. It is reversible.

23
Q

what is korsakoff’s psychosis?

A

prominent impairment of recent and remote memory but preservation of
immediate recall. There is no general cognitive impairment, retrograde and anterograde memory,
impaired learning and disorientation, may exhibit nystagmus and ataxia. Not consciously lying but
when dive deeper you find that they invent things to fill in gaps in their memory. Can lead to
irreversible problems.

24
Q

wenicke’s and korsakoff’s result due to lack of what?

A

Thiamine - B1

25
Q

why are alcoholics deficient in thiamine?

A

poor intake and

absorption, poor hepatic function, as an increased requirement for alcohol metabolism.

26
Q

what relationship problems can alcohol cause?

A 
• Aggression
o Verbal, physical
• Marital difficulties
o Morbid jealousy
• Poor parenting/neglect
o +/- loss of parenting rights
• Loss of friendships and social supports
27
Q

list 4 screening tools for alcoholism

A

CAGE (>2)
• AUDIT (Alcohol Use Disorders Identification Test) (10 questions)
• FAST (4 questions)
• PAT (Paddington Alcohol Test; used in A&Es)

28
Q

describe the CAGE Screening tool

A

o Have you tried to Cut down?
o Have you felt Annoyed by people criticising your drinking?
o Have you felt Guilty about drinking?
o Have you felt the need to have an Eye-opener?

29
Q

medication for treatment of alcoholism

A

• Prevention of Wernicke-Korsakoff Syndrome
o Thiamine
• Management of alcohol withdrawal
o Benzodiazepines, commonly chlordiazepoxide
• Aversion/deterrent medication
o Disulfiram (Antabuse) – avoid all alcohol containing substances (mouth wash, cooking,
aftershave) can result in death
• Anti-craving medication
o Acamprosate (campral)
o Naltrexone
o Nalmefene
o (Baclofen) (hiccups) – not licensed in UK for alcohol

Year 3 (164 decks)

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