Alcohol - clincial

Question 1

What is one unit of alcohol

Answer 1

10ml or 8g pure ethanol

Question 2

Safe limits of alcohol for men and womem

Answer 2

Women - 14 units a week

Men - 21 units a week

Question 3

How is alcohol absorbed

Answer 3

From upper small intestine

via portal vein transported to liver

Question 4

Metabolism of alcohol

Answer 4

Some metabolised in stomach by alcohol dehydrogenase (AD)
Mostly metabolised in liver.
AD oxidises alcohol to acetaldehyde (in cytosol)
Acetylaldehyde dehydrogenase then oxidises acetaldehyde to acetic acid (in mitochondria)
NAD+ helps this reaction take place by being reduced to NADH
+_+ cytochrome p4502e1 also involved

Question 5

Disulfiram effect on metabolism

Answer 5

Inhibits acetlyaldehyde dehydrogenase

When ethanol is consumed causes flushing, tachycardia, hyperventilation and panic due to excessive acetaldehyde in blood

Question 6

How quickly does the body metabolise alcohol

Answer 6

1 unit per hour

Question 7

Bad physical effects of alcohol

Answer 7

• Increased risk of oral, head and neck cancers with spirits and injunction with smoking
• Alcoholic cardiomyopathy
• systemic hypertension
• Korsakoff’s syndrome (thamine deficiency); memory loss, character change
• Wernicke’s encephalopathy (underweight, jerky eye movements, poor balance)

Question 8

Symptoms of alcohol poisoning

Answer 8

• confusion
• lack of coordination
• vomiting
• irreglar/ slow breathing
• blue tinged skin
• low body tem
• stupor
• unconcious

Question 9

Barretts oesophagus

Answer 9

Change from squamous to columnar epithelium
Men, middle aged, overwight, smoke and drink to excess
cell change can result in cancer

Question 10

Types of hiatus hernia

Answer 10

SLIDING; just top of oesophagus

ROLLING; fundus of stomach moves up too

Question 11

Alcohol effects on stomach

Answer 11

• acute gastritis
• acute or chronic ulceration
• portal gastropathy

Question 12

Alcohol excess causing bleeding

Answer 12

Vomiting up blood is ulceration in duodenum

Lower down large intestine would cause maleana black stool

Question 13

Alcohol has effect on…

Answer 13

Pancreas (chronic pancreatitis)

Liver (alcoholic liver disease)

Question 14

Normal liver functions

Answer 14

protein synth (albumin, clotting factors)
glycogen storage
deamination
detoxification of xenobiotics, hormones and ingested drugs
bilirubin metabolism

Question 15

Stages of alcoholic liver disease

Answer 15

1. acute fatty change
2. alcoholic hepatitis
3. hepatic fibrosis
4. cirrhosis
5. hepatocellular carcinoma

Question 16

1. acute fatty change

Answer 16

in acinar zone 3
mainly large droplet
may cause acute hepatic failure
reversible on withdrawal of alcohol

Question 17

2. alcoholic hepatitis

Answer 17

fatty change, mainly large droplet
mallory’s hyaline
breakdown of keratinocytes causing inflammation
reversible

Question 18

3. Hepatic fibrosis

Answer 18

starts in acinar zone 3
initially pericellular fibrosis
activation of hepatic stellate cell causes
reversible on withdrawal

Question 19

4. cirrhosis

Answer 19

Has liver failure, portal hypertension and hepatocellular carcinoma effects

Question 20

4. cirrhosis

liver failure

Answer 20

Low albumin
Coagulation problems > bleeding
hyperoestrogenism (gynaecomastia, gonadal atrophy, Dupuytren's contractureliver palms, spider naevi)
jaundice
encephalopathy (confused)

Question 21

4. cirrhosis

portal hypertension

Answer 21

ascites
varices
splenomegaly

Question 22

5. hepatocellular carcinoma

Answer 22

Very poor prognosis 6-9 months

raised serum alpha-fetoprotein levels

Question 23

CAGE questions

Answer 23

Every thought...
Cutting down?
Angry for criticizing drinking?
Guilty for drinking?
Eye opener (to wake up/ steady nerves/ hangover)

NEED 2 OR MORE for significance