Alcohol: Clinician's Perspective Flashcards
Which country in the UK has the highest rate of alcohol related deaths?
Scotland
How much does alcohol cost the NHS each year?
£3.5 billion (12% of total NHS spending on hospitals)
What can affect the medical consequence of alcohol?
Age, gender, BMI, pattern and volume of alcohol consumption, length of time someone has been consuming alcohol
How early can alcohol withdrawl begin?
6-8 hours after last drink
What are some features of mild alcohol withdrawl?
12-36 hrs from last drink = fine tremor, sweating, anxiety, raised heart rate and BP, hyperactivity, fever, anorexia, nausea, retching
What are some features of moderate alcohol withdrawl?
12hrs-5 days from last drink = course tremor, shaking, agitation, confusion, disorientation, paranoia, seizures, hallucinations
When are patients most susceptible to seizures?
12-48 hours after last drink
What are some features of severe alcohol withdrawl?
12hrs-7+ days after last drink = severe agitation, anxiety, confusion, dellusions, hallucinations, circulatory collapse, death
When are patients at risk of DTs?
Around 48 hrs after last drink
What are the hallucinations of alcohol withdrawl like?
Tactile and visual, “crawling bugs”
What are the features of alcohol consumption?
Sedative, mild anaesthetic, activates pleasure/reward centres (dopamine/serotonin release), sense of well-being, disinhibition, euphoria
What are the features of alcohol intoxication?
Increased risk of accidental injury, garrulous, elated, aggression, drowsiness, slurred speech, unsteadiness, loss of consciousness
What are the features of an alcohol withdrawl seizure?
Sudden cessation/reduction of alcohol, 12-24 hours after last drink, generalise T-C, clustered over few hours
What are the features of an epileptic seizure?
Alcohol ingestion precipitates seizures in susceptible individuals, usually morning after intoxication, any pattern (T-C vs focal)
What is Peripheral neuropathy?
Sensorimotor axonal polyneuropathy (glove and stocking)
What are some features of peripheral neuropathy?
Burning pain, weakness, direct damage to peripheral nerves, nutritional deficiencies
What occurs in Compression neuropathy?
Temporary damage to myelin sheath (Saturday night palsy), radial nerve compression at humeral head
What are some features of acute myopathy?
After binge = myalgia, proximal weakness, swollen tender muscle, raised CK, recovers over weeks to months
What are some features of chronic myopathy?
Develops over weeks to months = painless, proximal weakness and atrophy, normal CK, low K, PO4, incomplete recovery takes months
What is Wernickes encephalopathy?
Thiamine deficiency and cytotoxic oedema in mamillary bodies
What are some features of Wernickes encephalopathy?
Occular dysfunction (nystagmus to complete opthalmoparesis), ataxic gait, acute confusion
How is Wernickes encephalopathy treated?
Urgent thiamine replacement (recovery within hours)
What is Korsakoff Syndrome?
Cerebral atrophy resulting from Wernickes encephalopathy
What are some features of Korsakoff syndrome?
Profound anterograde amnesia (unable to retain new info), variable retrograde amnesia (episodic memory), confabulation, generally lack insight
What is confabulation?
Patient replaces memory with info they are able to retain at the time and believes this to be true
How is Korsakoff syndrome treated?
Abstinence and nutrition (recovery chances low)
What are some other neurological medical complications of alcohol?
Dementia, stroke (haemorrhagic), depression, head injury/SDH, cerebellar disease (acute intoxication/chronic cerebellar atrophy)
How does alcohol impact coronary artery disease?
Increases BP and lipids
How much alcohol needs to be consumed for a cardiomyopathy to develop?
Usually 8-9 units/day for 5+ years
How does alcohol cause cardiomyopathies?
Alcohol impairs ventricular function (calcium homeostasis, mitochondrial effects, signal transduction)
What can prolonged exposure to alcohol do in the heart?
Cause chronic inflammation and fibrosis of myofibrils
What are some acute arrhythmias linked to alcohol?
AF, SVT known as “holiday heart” (usually resolves within 24 hours)
What are some chronic arrhythmias linked to alcohol?
Long QT syndrome (due to electrolyte imbalance), dilated cardiomyopathy (atrial and ventricular arrhythmias)
What is the 5th most common cause of death in the UK?
Liver disease
What age group is most affected by liver disease?
Young working age people(<60)
What does >30 units/week cause a rapid rise in?
Cirrhosis
What is the progression of liver disease?
Regular heavy drinking-fat accumulation in hepatocytes-inflammation-fibrosis-cirrhosis
What percentage of heavy drinkers develop cirrhosis?
Only 10-20%
How does alcohol-related steatosis commonly present?
Abnormal LFTs
What happens in alcoholic-related steatosis?
Hepatocytes swell with triglycerides
Is alcoholic-related steatosis reversible?
It can be reversed with cessation
What is alcohol-related hepatitis and how does it present?
Parenchymal inflammation and hepatocyte damage. Presents with jaundice, coagulopathy, liver failure, sick and often worsen during first few weeks of admission
What are alcohol-related hepatitis patients at risk of?
Renal failure, bleeding, infections
What is alcohol-related cirrhosis?
Progressive fibrosis causing architectural distortion then cirrhosis +/- portal hypertension
What is compensated cirrhosis?
Normal liver function and physical function
What is decompensated cirrhosis?
Impaired synthetic function, ascites, encephalopathy
What are some features of portal hypertension?
Variceal bleeding, ascites, SBP
How does hepatic encephalopathy arise?
Portosystemic shunting through collaterals-failure to clear toxins/ammonia from blood-crosses blood brain barrier
What are some treatments for alcoholic liver disease?
Abstinence, vitamins, nutrition, endoscopic, pharmacological (beta blockers, lactulose, Rifaximin), TIPSS, transplant
How much alcohol increases your risk of cancer?
1.5 units/day increases risk of breast cancer (5%), pharyngeal cancer (17%) and oesophageal small cell cancer (30%)
Why is alcohol linked to cancer?
Its intermediate acetaldehyde is carcinogenic
Where is most alcohol broken down into acetaldehyde?
In the liver by ADH
Where else is ADH expressed?
Stomach and UGI mucosa
Why does alcohol increase the risk of breast cancer?
Oestrogen levels are increased
What are some co-carcinogens of alcohol?
Tobacco, HCV/HBV
What other medical conditions can arise from alcohol?
Injuries, STI, unplanned pregnancy, suicide, pancreatitis, pneumonia, mental health disorders, obesity, TB, psoriasis
What can clinicians do?
Raise awareness, prioritise patients, brief intervention (i.e identification and brief advice), alcohol support services
What are the NICE recommendations for alcohol treatment?
Promote abstinence and reduce alcohol consumption
What are some pharmacological interventions?
Acamprosate (reduces craving), Naltrexone (reduces desire for alcohol), Disulfiram (aversion therapy drug), Nalmefene (opioid antagonist)
How have the government helped to reduce alcohol consumption?
Lowered drink-drive limit from 80 to 50mg/100 ml blood, increased taxation, minimum unit pricing
