Alcohol - clinicians perspective Flashcards
how percentage of deaths is alcohol responsible for?
6%
does the same volume of alcohol effect everyone the same?
no
age, gender, BMI, pattern and volume of consumption and length of time all important
how long does it take for withdrawal symptoms to occur?
little as 6-8 hrs
describe mild moderate and severe withdrawal
mild - fine tremor, anxous, increased HR and BP, fever, unwell
moderate - course tremor, agitated, confused, seizures, hallucinations
severe - similar to moderate but worse, risk of emergency, circulatory collapse and death
how is withdrawal treated?
benzodiazepines (diazepam)
effects of alcohol consumption vs intoxication on CNS?
consumption - anaesthetic, pleasure centre activated, disinhibition etc
intoxication - injury, aggressive, drowsy etc
how is alcohol related to seizures?
can bring on episode in epileptics etc
consumption and withdrawal can both cause seizures
what is wernicke encephalopathy?
thiamine deficiency and cytotoxic oedema in mammillary bodies
what is the triad of signs/symptoms of Wernicke encephalopathy?
ocular dysfunction
ataxic gait
acute confusion
(might not have all 3)
how is Wernicke encephalopathy treated and why?
thiamine replacement
will progress to koraskoff syndrome if untreated
what is koraskoff syndrome and how is it treated?
irreversible cerebral atrophy
anterograde/reterograde amnesia
confabulation
lack of insight
how is koraskoff syndrome treated?
abstinence and nutrition but recovery not good
is alcohol directly linked to cardiovascular disease?
no
just affects risk factors (e.g - BP, lipids etc)
what heart conditions is alcohol associated with?
dilated cardiomyopathy
arrhythmias (acute - e.g holiday heart, AF or chronic - eg. long QT, atrial/ventricular arrhythmias)
does alcohol related liver disease improve with abstinence?
yes (Mostly)
how is alcohol metabolised mainly?
oxidative pathways in the liver
how does drinking progress to cirrhosis? how common is this?
drinking > fat accumulation in hepatocytes > inflammation > fibrosis > architectural distortion > cirrhosis +/- portal hypertension
only 10-20% of heavy drinkers
what is alcohol related steatosis and how is it treated?
accumulation of fat in hepatocytes after heavy drinking (often acute)
reverses with cessation
what is alcoholic hepatitis and what are the signs?
parenchymal inflammation and hepatocyte damage
jaundice, coagulopathy, liver failure, sick which worsens during first weeks of admission
what are the risks of alcoholic hepatitis and how is it treated?
can be life threatening
renal failure, bleeding, infections
treated with abstinence and nutrition (sometimes steroids)
does everyone with cirrhosis get unwell?
no some are compensated but can progress to decompensated
what are the associated risks with cirrhosis?
variceal bleed ascites spontaneous bacterial peritonitis hepatic encephalopathy hepatocellular encephalopathy nutritional decline (e.g ascites has high calorie demand)
what treatments are used for alcoholic liver disease?
abstinence vitamins nutrition endoscopic B blockers lactulose rifaximin TIPPS transplant
what % of cancers are alcohol related and which ones?
4% mouth/throat pharyngeal oesophageal stomach breast liver pancreas colon
