Alcohol abuse/ dependence 1A Flashcards
Define hazardous drinking?
This is consumption of alcohol that increases risk of harm. This is the stage before harmful drinking
What is harmful drinking?
this is drinking that adversely affects physical or mental health
What is dependence?
this is the prolonged and compulsive use of a substance leading to addiction, tolerance and the potential for withdrawal symptoms. The metrics for dependence include the following; - Tolerance, - withdrawal (physical = hand tremors, nausea, sweating, visual hallucination and seizures) (psychological symptoms= irritability, anxiety, depression, restlessness, - desire, - time, - activities
What are the physical presentations of alcohol abuse on the liver?
ascites, fatty liver disease, cirrhosis and liver failure
What are the GI symptoms presented in alcohol abuse?
diarrhoea, vomiting, varices (hematemesis / melena), oesophageal erosions, pancreatitis, Gi cancer
What are neurological symptoms presented in alcohol abuse?
memory & cognitive impairment, peripheral neuropathy, seizures, falls, wernickes encephalopathy & korasakoff
What are the psychological symptoms that present in alcohol abuse?
psychosis, morbid jealousy e.g. delusions that their partner is unfaithful, alcoholic hallucination (auditory in chronic alcoholism and visual or tactile in withdrawal states)
What are the cardiovascular symptoms seen in alcohol abuse?
arrhythmia, HTN, cardiomyopathy
What are the other presentations seen in alcohol abuse?
anaemia (macrocytic), osteoporosis, reduced fertility, breast Ca, accident and social problems
What is the initial identification tool used in investigating alcohol abuse?
CAGE tool
What are the further assessment tools used in alcohol abuse?
AUDIT, SADQ, APQ
What investigation can be carried out if health problems are suspected?
FBC (macrocytic anaemia, LFT (raised GGT, really raised AST, raised ALT)
What should be offered to diagnose cirrhosis in persistent heavy drinkers?
transient elastography (fibroscan)
What medications are given in the management of alcohol abuse?
benzodiazepine (chloradiazepoxide/diazepam), thiamine (to prevent neurological complications)
What medication can be given to prevent relapse after withdrawal?
acamprosate or naltrexone
What is an important social issue to consider in patients with alcohol abuse?
safeguarding issues e.g. child neglect or domestic abuse
What are the signs of alcohol withdrawal?
seizures, hallucinations and delirium tremens
Typically how long after last drink do patients experience signs and symptoms of alcohol withdrawal?
6-24hrs
What are the physical signs of alcohol withdrawal?
tremor, sweats and nausea
What are the psychological symptoms of alcohol withdrawal?
insomnia, altered mood, alcohol hallucinosis
What type of seizures is associated with alcohol withdrawal and how long does after last drink does it typically occur?
generalised tonic -clonic seizures and 12-48hrs after last drink
What type of visual hallucinations do people with alcohol withdrawal experience?
lilliputan hallucinations where things and people seem smaller
Do people with alcohol hallucinisos due to alcohol withdrawal experience tactile hallucinations?
yes, e.g. formication where they feel insects crawling on and under the skin
What is the timeline for delirium tremens?
3-7 days after last drink
What is experienced in delirium tremens?
delirium, confusion, tremor and seizures, increased HR and low BP
What is the management of alcohol withdrawal?
ABC(airway, breathing, circulation), monitor symptoms with CIWA-AR assessment scale, benzodiazepines PO for sedation and seizure and nutritional support (thiamine, folate, and electrolyte correction i.e. glucose, K+, Mg and Po
What is the name of the neurological syndromes caused by thiamine deficiency (B1)?
Wernickes encephalopathy and Korsakoff
How does alcohol misuse result in reduced thiamine intake?
from poor nutrition and impaired GI absorptions
What is wernickes encephalopathy?
this is an acute presentation of thimine deficiency which can be sometimes mistaken for intoxication
What is the triad of wernickes encephalopathy?
COG(confusion, opthalmoplegia: nystagmus and LR6 palsy and Gait: ataxia with wide gait)
What is korsakoff syndrome?
this is the chronic manifestation of thiamine deficiency
What are classic symptoms observed in korsakoff syndrome?
anterograde amnesia, retrograde amnesia and confabulation to fill in memory gaps
