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CLASP Year 2 > Alcohol: Clinician's Perspective > Flashcards

Alcohol: Clinician's Perspective Flashcards

1
Q

Which country in the UK has the highest rate of alcohol related deaths?

A

Scotland

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2
Q

How much does alcohol cost the NHS each year?

A

£3.5 billion (12% of total NHS spending on hospitals)

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3
Q

What can affect the medical consequence of alcohol?

A

Age, gender, BMI, pattern and volume of alcohol consumption, length of time someone has been consuming alcohol

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4
Q

How early can alcohol withdrawl begin?

A

6-8 hours after last drink

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5
Q

What are some features of mild alcohol withdrawl?

A

12-36 hrs from last drink = fine tremor, sweating, anxiety, raised heart rate and BP, hyperactivity, fever, anorexia, nausea, retching

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6
Q

What are some features of moderate alcohol withdrawl?

A

12hrs-5 days from last drink = course tremor, shaking, agitation, confusion, disorientation, paranoia, seizures, hallucinations

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7
Q

When are patients most susceptible to seizures?

A

12-48 hours after last drink

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8
Q

What are some features of severe alcohol withdrawl?

A

12hrs-7+ days after last drink = severe agitation, anxiety, confusion, dellusions, hallucinations, circulatory collapse, death

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9
Q

When are patients at risk of DTs?

A

Around 48 hrs after last drink

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10
Q

What are the hallucinations of alcohol withdrawl like?

A

Tactile and visual, “crawling bugs”

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11
Q

What are the features of alcohol consumption?

A

Sedative, mild anaesthetic, activates pleasure/reward centres (dopamine/serotonin release), sense of well-being, disinhibition, euphoria

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12
Q

What are the features of alcohol intoxication?

A

Increased risk of accidental injury, garrulous, elated, aggression, drowsiness, slurred speech, unsteadiness, loss of consciousness

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13
Q

What are the features of an alcohol withdrawl seizure?

A

Sudden cessation/reduction of alcohol, 12-24 hours after last drink, generalise T-C, clustered over few hours

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14
Q

What are the features of an epileptic seizure?

A

Alcohol ingestion precipitates seizures in susceptible individuals, usually morning after intoxication, any pattern (T-C vs focal)

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15
Q

What is Peripheral neuropathy?

A

Sensorimotor axonal polyneuropathy (glove and stocking)

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16
Q

What are some features of peripheral neuropathy?

A

Burning pain, weakness, direct damage to peripheral nerves, nutritional deficiencies

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17
Q

What occurs in Compression neuropathy?

A

Temporary damage to myelin sheath (Saturday night palsy), radial nerve compression at humeral head

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18
Q

What are some features of acute myopathy?

A

After binge = myalgia, proximal weakness, swollen tender muscle, raised CK, recovers over weeks to months

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19
Q

What are some features of chronic myopathy?

A

Develops over weeks to months = painless, proximal weakness and atrophy, normal CK, low K, PO4, incomplete recovery takes months

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20
Q

What is Wernickes encephalopathy?

A

Thiamine deficiency and cytotoxic oedema in mamillary bodies

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21
Q

What are some features of Wernickes encephalopathy?

A

Occular dysfunction (nystagmus to complete opthalmoparesis), ataxic gait, acute confusion

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22
Q

How is Wernickes encephalopathy treated?

A

Urgent thiamine replacement (recovery within hours)

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23
Q

What is Korsakoff Syndrome?

A

Cerebral atrophy resulting from Wernickes encephalopathy

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24
Q

What are some features of Korsakoff syndrome?

A

Profound anterograde amnesia (unable to retain new info), variable retrograde amnesia (episodic memory), confabulation, generally lack insight

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25
Q

What is confabulation?

A

Patient replaces memory with info they are able to retain at the time and believes this to be true

26
Q

How is Korsakoff syndrome treated?

A

Abstinence and nutrition (recovery chances low)

27
Q

What are some other neurological medical complications of alcohol?

A

Dementia, stroke (haemorrhagic), depression, head injury/SDH, cerebellar disease (acute intoxication/chronic cerebellar atrophy)

28
Q

How does alcohol impact coronary artery disease?

A

Increases BP and lipids

29
Q

How much alcohol needs to be consumed for a cardiomyopathy to develop?

A

Usually 8-9 units/day for 5+ years

30
Q

How does alcohol cause cardiomyopathies?

A

Alcohol impairs ventricular function (calcium homeostasis, mitochondrial effects, signal transduction)

31
Q

What can prolonged exposure to alcohol do in the heart?

A

Cause chronic inflammation and fibrosis of myofibrils

32
Q

What are some acute arrhythmias linked to alcohol?

A

AF, SVT known as “holiday heart” (usually resolves within 24 hours)

33
Q

What are some chronic arrhythmias linked to alcohol?

A

Long QT syndrome (due to electrolyte imbalance), dilated cardiomyopathy (atrial and ventricular arrhythmias)

34
Q

What is the 5th most common cause of death in the UK?

A

Liver disease

35
Q

What age group is most affected by liver disease?

A

Young working age people(<60)

36
Q

What does >30 units/week cause a rapid rise in?

A

Cirrhosis

37
Q

What is the progression of liver disease?

A

Regular heavy drinking-fat accumulation in hepatocytes-inflammation-fibrosis-cirrhosis

38
Q

What percentage of heavy drinkers develop cirrhosis?

A

Only 10-20%

39
Q

How does alcohol-related steatosis commonly present?

A

Abnormal LFTs

40
Q

What happens in alcoholic-related steatosis?

A

Hepatocytes swell with triglycerides

41
Q

Is alcoholic-related steatosis reversible?

A

It can be reversed with cessation

42
Q

What is alcohol-related hepatitis and how does it present?

A

Parenchymal inflammation and hepatocyte damage. Presents with jaundice, coagulopathy, liver failure, sick and often worsen during first few weeks of admission

43
Q

What are alcohol-related hepatitis patients at risk of?

A

Renal failure, bleeding, infections

44
Q

What is alcohol-related cirrhosis?

A

Progressive fibrosis causing architectural distortion then cirrhosis +/- portal hypertension

45
Q

What is compensated cirrhosis?

A

Normal liver function and physical function

46
Q

What is decompensated cirrhosis?

A

Impaired synthetic function, ascites, encephalopathy

47
Q

What are some features of portal hypertension?

A

Variceal bleeding, ascites, SBP

48
Q

How does hepatic encephalopathy arise?

A

Portosystemic shunting through collaterals-failure to clear toxins/ammonia from blood-crosses blood brain barrier

49
Q

What are some treatments for alcoholic liver disease?

A

Abstinence, vitamins, nutrition, endoscopic, pharmacological (beta blockers, lactulose, Rifaximin), TIPSS, transplant

50
Q

How much alcohol increases your risk of cancer?

A

1.5 units/day increases risk of breast cancer (5%), pharyngeal cancer (17%) and oesophageal small cell cancer (30%)

51
Q

Why is alcohol linked to cancer?

A

Its intermediate acetaldehyde is carcinogenic

52
Q

Where is most alcohol broken down into acetaldehyde?

A

In the liver by ADH

53
Q

Where else is ADH expressed?

A

Stomach and UGI mucosa

54
Q

Why does alcohol increase the risk of breast cancer?

A

Oestrogen levels are increased

55
Q

What are some co-carcinogens of alcohol?

A

Tobacco, HCV/HBV

56
Q

What other medical conditions can arise from alcohol?

A

Injuries, STI, unplanned pregnancy, suicide, pancreatitis, pneumonia, mental health disorders, obesity, TB, psoriasis

57
Q

What can clinicians do?

A

Raise awareness, prioritise patients, brief intervention (i.e identification and brief advice), alcohol support services

58
Q

What are the NICE recommendations for alcohol treatment?

A

Promote abstinence and reduce alcohol consumption

59
Q

What are some pharmacological interventions?

A

Acamprosate (reduces craving), Naltrexone (reduces desire for alcohol), Disulfiram (aversion therapy drug), Nalmefene (opioid antagonist)

60
Q

How have the government helped to reduce alcohol consumption?

A

Lowered drink-drive limit from 80 to 50mg/100 ml blood, increased taxation, minimum unit pricing

CLASP Year 2 (10 decks)

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