Alcohol Flashcards
What are the affects of alcohol in lower doses?
- Euphoria
- Reduced anxiety
- Relation
What are the affects of alcohol in higher doses?
- Intoxication (the pathological state produced by a drug, serum, alcohol, or any toxic substance; poisoning)
- Impaired attention and judgement
- Unsteadiness
- Flushing
- Nystagmus
- Mood instability
- Disinhibition
- Slurring
- Stupor
- Unconsciousness
What is the harful use of alcohol classified as?
Harmful use: pattern of use causing damage to physical or mental health. Use >1 month or repeatedly over 12 months
How is alcohol dependence diagnosed?
○ Dependence: 3 or more of the following for >1 month or repeatedly over 12 months
- Cravings/ compulsions to take
- Difficulty controlling use
- Primacy (where you rank alcohol in your priorities)
- Increased tolerance
- Physiological withdrawal on reduction/ cessation
- Persistence despite harmful consequences
What is the definition of a withdrawal state?
Withdrawal state: Group of symptoms of variable clustering and severity on complete/ relative withdrawal of a psychoactive substance, after persistent use of that substance
What are the symptoms of the alcohol withdrawal state?
○ Tremor ○ Weakness ○ Nausea ○ Vomiting ○ Anxiety ○ Seizures ○ Confusion ○ Agitation ○ Death ○ Delirium Tremens
What neurological problems can alcohol cause?
□ Brain damage □ Loss of memory □ Hallucinations □ Fits □ Dementia □ Tingling nerves □ Numbness □ Trembling hands □ Confusional state □ Korsakoff's/ Wernicke's
What is Korsakoff’s/ Wernicke’s caused by?
® Caused by thiamine deficiency
◊ Poor intake and poor absorption
◊ Poor hepatic function
◊ Increased requirement for alcohol metabolism
What are the symptoms of Wenicke’s encephalopathy?
◊ Confusion
◊ Ataxia
◊ Ophthalmoplegia
◊ Nystagmus
What are the symptoms of Korsakoff’s psychosis?
◊ Prominent impairment of recent and remote memory ◊ Preservation of immediate recall ◊ No general cognitive impairment ◊ Retrograde and antegrade memory ◊ Impaired learning and disorientation ◊ May exhibit nystagmus and ataxia
What pulmonary problems can alcohol cause?
□ Risk of chest infection
□ Infection
What cardiovascular problems does alcohol cause?
□ Enlarges heart
□ High blood pressure
□ Irregular
What GI problems does alcohol cause?
□ Swollen liver □ Hepatitis □ Cirrhosis □ Pancreatitis □ Ulcers □ Gastritis □ Vomiting blood
What reproduction problems does alcohol cause?
□ Risk of STIs and HIV/ AIDs
□ Impotence in men
□ Infertility in women
What physical problems (other than in neuro, cadio, pulmonary, GI and repro) does alcohol cause?
- Endocrine □ Poor control of diabetes - MSK □ Loss of muscle - Accidental injury - Violence - Cancer □ Mouth □ Oesophagus □ Liver
What mental health problems does alcohol cause?
- Anxiety
- Depression
- Sleep disruption
□ Doesn’t promote REM sleep which helps with long term and short term memory - Morbid jealousy
- Alcoholic hallucinosis
□ Has a similar nature as delirium Tremens but not as severe and not life threatening - Deliberate self-injury
- Suicidal thoughts/ acts
What problems outside of physical and mental health problems does alcohol cause?
○ Relationships - Aggression □ Verbal □ Physical - Marital difficulties □ Morbid jealousy - Poor parenting/ neglect +/- loss of parenting rights - Loss of friendships and social support ○ Employment, financial ○ Legal
What are the staging tools for alcohol?
○ CAGE
- Have you tried to Cut down?
- Have you ever felt Annoyed by people criticising your drinking?
- Have you ever felt Guilty about drinking?
- Have you felt the need to have an Eye-opener?
○ AUDIT (alcohol Use Disorders Identification Test)
○ FAST (4 questions)
○ PAT (Paddington Alcohol Test; used in A and E)
How is alcoholism managed?
○ Practical advice, education, harm reduction
○ Holistic/ bio-psycho-social approach
- Support for the patient and family
- Psychological help (e.g. CBT, group therapy)
- Social work input (benefits, housing, child protection)
- Skill training
- Community support (e.g. AA, ADA)
- Inpatient or residential treatment
- Medication
What medication is given in the managment of alcoholism?
□ Prevention of Wernicke-Korsakoff syndrome ® Thiamine □ Management of alcohol withdrawal ® Benzodiazepines, commonly chlordiazepoxide □ Aversion/ deterrent medication ® Disulfiram (Antabuse) □ Anti-craving medication ® Acamprosate ® Naltrexone ® Nalmefene ® (Baclofen)
How is fatty liver diagnosed?
US, CT, MRI
What is fatty liver?
○ >60g of alcohol daily
○ Liver cells replaced by fatty acids and glycerol
○ Benign and reversable
○ Can progress to acute liver cirrhosis
Talk about acute alcoholic hepatitis
○ >8 units of alcohol a day
○ Severe inflammation of the liver
○ No treatment at the moment
Talk about varices
○ Secondary to cirrhosis and PHT (pulmonary hypertension)
○ Oesophagus, stomach, abdominal wall and rectum
○ >size >pressure >risk of bleeding
○ Every bleed is associated with 30% mortality
