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Psychiatry > Alcohol and the Liver > Flashcards

Alcohol and the Liver Flashcards

1
Q

What are the functions of the liver

A 
Process alcohol 
Carbohydrate metabolism 
Fat metabolism 
Protein metabolism
Storage
Synthesis 
Bile production 
Kupffer cells - rubbish collector 
Conjugate bilirbuin
Metabolise drugs
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2
Q

How does liver process alcohol

A

Alcohol broken to acetyladehydrate - using ADH / ALDH
Further to Acetate
Further to FA, CO2, H20
Overload leads to build up of toxic chemicals

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3
Q

What does liver synthesise

A

Albumin
Clotting factor - fibrinogen
Thrombopoeitin - production of platelet

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4
Q

What does liver store

A

Glucose
Iron - ferritin (transferrin + ferropoeitin)
Copper
Vitamins

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5
Q

Recommended drinking

A

<14 units per week
Over 3 days
>100 = serious liver

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6
Q

Why are only some heavy drinkers affected by liver disease

A 
Genetics - polymorphism of enzyme 
Nutritional deficiency / poor diet 
Co-exisitng virus
Other drug
Female
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7
Q

What causes liver cirrhosis

A 
Alcohol 
NAFLD 
Hep C
Autoimmune
Other
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8
Q

What gives an indication of stage of liver disease

A

Fibroscan

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9
Q

How does liver disease progress

A 
Normal
Fatty liver (steatosis) 
Steatohepatitis
Fibroisis
Liver cirrhosis
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10
Q

What causes fatty

A

FA’s deposited
Progress to inflammation
Reversible

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11
Q

What is fibrosis

A

Chronic inflamamtory by Stellate and Kuppfer cells

Scarring and collagen production

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12
Q

What is cirrhosis and what is seen on USS

A

Fibrosis
Loss of structure
Collagen between vein
Scallop edge on USS

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13
Q

What are complications of liver disease

A

Variceal haemorrhage
Encephalopathy as ammonia builds up
Ascites
HCC

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14
Q

What is alcoholic hepatitis

A

Fatty change
Leucocyte infiltration
Hepatic necrosis

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15
Q

How does alcohol hepatitis present

A 
HSM
Jaundice
Abdominal pain
Fever 
Can present decompensated 
May or may not have cirrhosis
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16
Q

How do you measure severity

A

Glasgow Alcohol Hepatitis Score
Age
Inflammation markers
Liver function

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17
Q

How do you treat alcohol hepatitis

A

Abstinence
Steroid if Maddrey >32
Rx infection
Nutrition

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18
Q

What are complications of alcohol hepatitis

A

Renal

Coagulopathy

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19
Q

What screening tools can be used for harmful alcohol use

A

CAGE - cutting down, annoyed, guilt, eye opener

FAST

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20
Q

What should you get in history

A 
What
How much
How often
Dependence
Complications
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21
Q

What medication can be offered if drinking too much

A

Thiamine (B1) - Paprinex if diet deficient
Deterrant
Anti-craving
Withdrawal Rx

22
Q

What is 1st line in withdrawal and what one

A

Benzodiazepine

  • Chlordiazepoxide = quick and long acting = 1st line (Librium)
  • Diazepam 2nd line
23
Q

What else can you give in withdrawal

A

Carbamazepine

Haloperidol

24
Q

What is deterrent medication

A

Disulifram
Makes you feel sick as decrease metabolism by inhibiting enzyme the breaks down
Take every day
CI IHD or psychosis

25
Q

What is anti-craving medication

A

Acramrosate = 1st line
Naltrexone
Buclofen - muscle relaxant

26
Q

What is the treatment for alcohol abuse

A

Practical advice
Education
Harm reduction
Social work input - housing / child protection / benefit

27
Q

What is psychological treatment

A 
CBT
Motivational interview 
12 step programme
AA
Skills training
28
Q

What are other physical complications

A 
Hallucination
Dementia
Infection
High BP 
Lose of muscle mass
Impotence
Infertility
Poor DM
Pancreatitis
Cancer
29
Q

What are mental complications

A 
Depression
Anxiety
Sleep / insomnia 
Psychosis 
Morbid jealously - Orthello 
Self injury / suicide
30
Q

What other problems

A 
Aggression
Marital
Financial 
Occupation
Isolation
Neglect
Poor parenitng
Legal
31
Q

What are signs of chronic alcohol use

A 
Elevated gamma GT
Macrocytosis
Low platelet
Elevated ferritin
Abnormal LFT
Low albumin
Abnormal clotting
32
Q

What are signs of alcohol withdrawal

A 
Tremor
Tachycardia
Sweat
N+V
Anxiety
Weakness
Confusion
Agitation
Seizure - may present with this
33
Q

When does withdrawal happen

A

6-12 hours

Seizures at 36 hour

34
Q

What causes withdrawal

A

Opposite neurochemistry to alcohol (same as benzodiazepine)
Decreased GABA
Increased NMDA

35
Q

What should you do if someone in withdrawal and what is used for assessment

A

Admit till stable esp if seizure / DT
CLWA - withdrawal assessment
Severity and decide treatment

36
Q

When does delirium tremens occur and why

A

72 hours
Alcohol stimulates GABA and inhibits NMDA
When alcohol removed GABA under functions and NMDA over functions = increased adrenergic

37
Q

What are the symptoms of delirium tremens

A 
Profound confusion
Autonomic overactivity
Hallucination- tactile / visual 
Delusion
Tremor
Agitation
Fever / tachy / HTN 
Ataxia 
Arrhythmia
38
Q

What are the risks of DT

A 
Seizure
Self injury 
CVS collapse
Infection
Hyperthermia
39
Q

How do you Rx

A

Benzo 1st line (chlordiazepoxide or lorazepam)
Carbamazepine 2nd line
Haloperidol

40
Q

What does chronic alcohol lead too

A

B1 deficiency as decreased nutrition and increased requirement

41
Q

What can B1 defiincecy cause

A

Weirnecke’s

42
Q

Symptoms of Weirnecke’s

A 
Confusion
Ataxia
Opthalmopegia
Nystagmus
Peripheral neuropathy
43
Q

What will Weirnecke’s present to if not Rx

A

Korsakoff Psychosis which is irreversible

44
Q

What are symptoms of Korsakoff

A 
Impairment of recent and remote memory 
Immediate preserved
Impaired learning
Disorientated
Nystagmus
Ataxia
45
Q

How do you treat Weirnecke’s / Korsakoff

A

Thiamine

Give even if at risk and no signs

46
Q

What is the neurochemical disturbance in alcohol

A

Depressant so increased inhibitor signal - GABA

Decreased excitatory - NMDA

47
Q

What is harmful use

A

> 1 months or repeated over 12 months

48
Q

What is dependence 3+ >1 month or repeat

A 
>3+ >1 month or repeat
Craving 
Difficulty controlling
Tolerance
Withdrawal
Persistence despite harmful consequence 
Saline - highest priority
Primacy - first thing 
Narrow repoitre
49
Q

What score to assess alcohol withdrawal severity

A

CIWA

50
Q

What else be needed if someone presents with symptoms of Weirnecke / Korsakoff

A

CT to exclude subdural

Psychiatry (11 decks)

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