Alcohol - clinicians perspective

Question 1

how percentage of deaths is alcohol responsible for?

Answer 1

6%

Question 2

does the same volume of alcohol effect everyone the same?

Answer 2

no

age, gender, BMI, pattern and volume of consumption and length of time all important

Question 3

how long does it take for withdrawal symptoms to occur?

Answer 3

little as 6-8 hrs

Question 4

describe mild moderate and severe withdrawal

Answer 4

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

Question 5

how is withdrawal treated?

Answer 5

benzodiazepines (diazepam)

Question 6

effects of alcohol consumption vs intoxication on CNS?

Answer 6

consumption - anaesthetic, pleasure centre activated, disinhibition etc
intoxication - injury, aggressive, drowsy etc

Question 7

how is alcohol related to seizures?

Answer 7

can bring on episode in epileptics etc

consumption and withdrawal can both cause seizures

Question 8

what is wernicke encephalopathy?

Answer 8

thiamine deficiency and cytotoxic oedema in mammillary bodies

Question 9

what is the triad of signs/symptoms of Wernicke encephalopathy?

Answer 9

ocular dysfunction
ataxic gait
acute confusion
(might not have all 3)

Question 10

how is Wernicke encephalopathy treated and why?

Answer 10

thiamine replacement

will progress to koraskoff syndrome if untreated

Question 11

what is koraskoff syndrome and how is it treated?

Answer 11

irreversible cerebral atrophy
anterograde/reterograde amnesia
confabulation
lack of insight

Question 12

how is koraskoff syndrome treated?

Answer 12

abstinence and nutrition but recovery not good

Question 13

is alcohol directly linked to cardiovascular disease?

Answer 13

no

just affects risk factors (e.g - BP, lipids etc)

Question 14

what heart conditions is alcohol associated with?

Answer 14

dilated cardiomyopathy

arrhythmias (acute - e.g holiday heart, AF or chronic - eg. long QT, atrial/ventricular arrhythmias)

Question 15

does alcohol related liver disease improve with abstinence?

Answer 15

yes (Mostly)

Question 16

how is alcohol metabolised mainly?

Answer 16

oxidative pathways in the liver

Question 17

how does drinking progress to cirrhosis? how common is this?

Answer 17

drinking > fat accumulation in hepatocytes > inflammation > fibrosis > architectural distortion > cirrhosis +/- portal hypertension
only 10-20% of heavy drinkers

Question 18

what is alcohol related steatosis and how is it treated?

Answer 18

accumulation of fat in hepatocytes after heavy drinking (often acute)
reverses with cessation

Question 19

what is alcoholic hepatitis and what are the signs?

Answer 19

parenchymal inflammation and hepatocyte damage

jaundice, coagulopathy, liver failure, sick which worsens during first weeks of admission

Question 20

what are the risks of alcoholic hepatitis and how is it treated?

Answer 20

can be life threatening
renal failure, bleeding, infections
treated with abstinence and nutrition (sometimes steroids)

Question 21

does everyone with cirrhosis get unwell?

Answer 21

no some are compensated but can progress to decompensated

Question 22

what are the associated risks with cirrhosis?

Answer 22

variceal bleed
ascites
spontaneous bacterial peritonitis
hepatic encephalopathy
hepatocellular encephalopathy
nutritional decline (e.g ascites has high calorie demand)

Question 23

what treatments are used for alcoholic liver disease?

Answer 23

abstinence
vitamins
nutrition
endoscopic
B blockers 
lactulose
rifaximin
TIPPS
transplant

Question 24

what % of cancers are alcohol related and which ones?

Answer 24

4%
mouth/throat
pharyngeal
oesophageal
stomach
breast
liver
pancreas
colon

Question 25

how might alcohol cause cancer?

Answer 25

alcohol > acetaldehyde (carcinogenic) > acetate

Question 26

how might alcohol lead to breast cancer?

Answer 26

oestrogen levels increased in drinkers

co-carcinogens tobacco and HCV/HBV together with drinking increase risk

Question 27

what drugs are available to help quit drinking?

Answer 27

Acamprosate
naltrexone
disulfiram
nalmefene