Alcohol and health Flashcards
Examples of one unit are
1 unit:
- half pint of a regular beer, lager or cider
- a small glass of wine
- a small glass of sherry
- a single measure of spirits
how to work out units based on % of alcohol?
% of unit in one litre = number of units in one litre
Is Alcohol withdrawal life threatening?
Yes - it leads to cardiac arrhythmias
Do the patient always need to completely stop drinking?
It would be good, but any reduction (e.g. 10% reduction in alco intake) will bring significant benefits
Bad effects of long term alcohol consumption
It is related to ‘large amount consumption’
Psychological aspects of alco consumption
- cravings
- irritability
- anti-sociality
- depression
- anxiety
- panic
- psychosis
- hallucinations
- delusions
- sleep disorder
How alcohol can affect sleep?
It lowers quality of sleep
*does not help with sleep
Pathway of alcohol-related liver disease
steatosis (fat accumulation in the liver) -> inflammation -> collagen deposition -> fibrosis -> cirrhosis -> hepatocellular carcinoma
What is typical characteristic feature of cirrhosis
Nodule formation
Acute alcoholic hepatitis
Clinical presentaiton
Acute alcoholic hepatitis
- rapid progression of jaundice
- fever
- abdominal pain
- leucocytosis
Histology of acute alcoholic hepatitis
- neutrophil infiltration
- marked fatty change
- Mallory’s hyaline
Consequences of liver cirrhosis
- portal hypertension
- poor liver function
- liver cancer
What (in re to alcohol disease) causes ascites?
Ascites may be a consequence of an increased portal hypertension and low albumin
Treatment of ascites
Ascites - transudate
- fluid restriction
- salt restriction
- diuretics
- paracentesis
- TIPS
What’s transudate ?
Fluid produced by an organ that has failed (e.g. HF, ascites)
TIPS
What’s that? (simply)
Stent put to bypass between hepatic vein and portal vein
Can the liver repair itself and regenerate?
It can, but only up to the point of cirrhosis
*cirrhosis is fixed - cannot get back from that
What’s the recommendation for pregnant women in terms of pregnancy?
No alcohol - the safest thing to do
Clinical presentation of Foetal Alcohol Syndrome
FAS
- mental retardation
- epicanthal folds
- flat nasal bridge
- deformed ears
- upturned nose
- smooth philtrum
- thin upper lip
What happens to alcohol consumed during pregnancy lead to FAS?
- Alcohol crosses the placenta -> entered into foetal circulation
- Alcohol metabolism in foetal tissues: alcohol + fatty acids -> fatty acids ethyl esters
*fatty acids ethyl esters can be detectable in meconium
What’s the name of the drug that is commonly used to Rx alcohol dependence?
Acamprosate
*used alongside with counselling
What’s the MoA of Acamprosate?
Acamprosate
* used to Rx alcohol dependence
MoA:
- NMDA receptor antagonist
Chronic alcohol consumption -> overproduction of NMDA
Stopping alcohol -> sudden additional upregulation of NMDA -> symptoms: delirium tremens and excitotoxic neuronal death
So antagonist of NMDA will help with these
- positive regulation of GABA-A
In chronic alco consumption, GABA is down-regulated; down- regulated GABA = less GABA = less opposition of neuronal excitation = withdrawal symptoms (if no alcohol)
Disulfiram - MoA and use in alcohol cessation
Disulfiram
Use: relapse prevention
MoA: blocks aldehyde dehydrogenase in the liver -> increased acetaldehyde -> effects of hungover and feeling as if ‘a person is gonna die’*
*therefore a person would be likely to avoid the alcohol intake
Role of benzodiazepines in alcohol cessation
MoA: Increase GABA -> fewer side effects of withdrawal
Use: medically assisted withdrawal
