Alcohol Misuse Flashcards
What are reasons for hospitalisation due to alcohol?
Injury Mental health and behavioural disorders Heart conditions/stroke Liver disease/pancreatitis Cancer
What are the functions of the liver?
Carb metabolism (glycogenesis/glycogenolysis)
Fat metabolism
Protein metabolism (deamination/transamination) & production of albumin
Storage of glucose, iron, copper, vitamins
Synthesis of fibrinogen and thrombopoetin
Production of bile
Metabolism of drugs and alcohol
What does thrombopoetin do?
Stimulate production of platelets in the bone marrow
What are Kupffer cells?
Specialised macrophages in the liver
How does the body process alcohol?
Alcohol absorbed in mouth, oesophagus, stomach, intestines
At liver, alcohol dehydrogenase breaks ethanol into acetaldehyde
Acetaldehyde broken down by aldehyde dehydrogenase into acetate
Acetate broken down into fatty acids, CO2 and water
How long does it take for a healthy liver to process 1 unit of alcohol?
1 hour
What happens in chronic consumption of alcohol?
Deposition of triglycerides in liver –> fatty liver disease
Inappropriate activation of stellate cells which produce collagen –> fibrosis and scar tissue
What is the recommended drinking allowance?
No more than 14 units spread over >3 days
Consuming >100 units/wk does what?
Puts you at 20% risk of developing serious liver disease
What are the majority of deaths due to alcohol due to?
Cirrhosis
What is the progression of alcohol related liver disease?
Normal liver –> steatosis –> hepatosteatosis –> fibrosis –> cirrhosis
Steatosis is reversible!
Why does alcohol consumption lead to steatosis?
Alcohol is calorie rich and fatty acids are produced from its metabolism - these are deposited around the CENTRAL vein and then the parenchyma
What are indicators of chronic alcohol use?
Elevated gamma GT Macrocytosis (enlarged RBCs) Low platelets Elevated ferritin Enlarged, smooth edged liver on AUSS
What changes occur to the liver in alcoholic hepatitis?
Infiltration of liver with leucocytes and necrosis
What are the symptoms of alcoholic hepatitis?
Hepatomegaly, jaundice, abdominal pain, fever, hepatic decompression
What can you use to measure 28 day survival without treatment in alcohol hepatitis?
Glasgow Alcoholic Hepatitis Score
Using age, inflammation markers and LFTs
How do you manage alcoholic hepatitis?
Steroids
Manage infection, nutrition, renal impairment or coagulation problems if they arise
What changes occur to the liver in liver fibrosis?
Chronic inflammation
Stellate cells activated –> collagen production
Localised fibrosis around the vein and loss of lobule structure
How can you assess the severity of cirrhosis?
Fibroscan –> less elastic = more likely to be cirrhosis
What are the complications of cirrhosis?
Variceal haemorrhage
Encephalopathy
Ascites
What cancer can occur in those with cirrhosis?
Hepatocellular carcinoma
What law controls alcohol use/selling?
Licensing act 2005
Not allowed to sell to U18 or drunk people or people buying on behalf of someone under 18
To have license must have training in dealing with intoxicated people and must record this training for inspection by police scotland
What are some equivalents to 14 units?
6 pints of beer
6 glasses of wine
14 shots
What are the effects of alcohol at lower doses?
Euphoria, increased sociability, reduced anxiety, relaxation
What are the effects of alcohol at higher doses?
Intoxication
Define intoxication
Pathological state induced by a drug/serum/alcohol (poisoning)
What is the ICD-10 criteria for alcohol dependence?
3+ for >1 month/repeadedly over 12 months:
- Increased tolerance
- Physiological withdrawal
- Neglect of other interests
- Continued use despite knowledge of harm
- Difficulty controlling use
- Primacy
- Compulsions/cravings
Define withdrawal state
Symptoms relating to the withdrawal of a substance after persistent use of that substance
Define harmful use of alcohol
Pattern of use causing damage to physical/mental health (over >1 month/repeatedly over 12 months)
What are the neurochemical effects of alcohol?
Depressant
Enhances inhibitory GABA A, glycine and adenosine
Reduces excitatory NDMA glutamate, aspartate
Promotes endogenous opioid release and endocannabinoid release
What are the symptoms of alcohol withdrawal?
N/V, tremor, anxiety, weakness, seizures, confusion, agitation, death
What is delirium tremens?
Profound confusion, tremor, agitation, hallucinations, delusions, insomnia, autonomic overactivity
Can lead to death (by CV collapse, infection, hyperthermia, seizures, self injury)
Usually 48-72h after alcohol stopped
What mortality is associated with delirium tremens?
5%
What kinds of problems does alcohol misuse cause?
Physical health Mental health Relationships Employment/financial Legal
What is Othello syndrome?
Repeated episodes of jealous, accusations of infidelity, searches for evidence etc. (may be due to schizophrenia, alcohol etc.)
What mental health problems are associated with alcohol?
Anxiety Depression Sleep disruption Morbid jealousy Hallucinations Self arm/suicide
State some physical health problems with chronic alcohol use
Loss of muscle HTN Ulcers/gastritis Brain damage Memory problems Risk of chest infection Liver problems Nerve problems Infertility/impotence
What cancers does alcohol misuse predispose to?
Mouth, oesophagus, liver
What is Korsakoff’s psychosis?
Thiamine deficiency –> retrograde and anterograde amnesia (immediate recall okay)
May also have impaired learning/disorientation, nystagmus, ataxia
What is Wernicke’s encephalopathy?
Thiamine deficiency –> ataxia, confusion, opthalmoplegia, nystagmus
What screening tools can you use for alcohol misuse?
CAGE
FAST
AUDIT
PAT
What are the 4 CAGE questions?
Have you tried to cut down?
Have you ever been annoyed by people criticising your drinking?
Have you ever felt guilty about your drinking?
Have you ever needed an eye-opener?
What is involved in the management of alcohol addiction?
Advice, education
Support for family and patient
CBT, family therapy
Social work input (benefits, children protection, housing)
Skills trainoing
Community support (e.g. AA)Inpatient/residential treatment
Medication
What medication is used for alcohol addiction?
Thiamine to prevent Wernicke’s/Korsakoff
Benzos (chlorodiazepoxide)
Aversion Rx - disulfiram
Anti-craving Rx - Acamprosate/naltrexone/nalmefene
