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psychiatry > Alcohol Misuse > Flashcards

Alcohol Misuse Flashcards

1
Q

What are reasons for hospitalisation due to alcohol?

A 
Injury 
Mental health and behavioural disorders
Heart conditions/stroke
Liver disease/pancreatitis
Cancer
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2
Q

What are the functions of the liver?

A

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

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3
Q

What does thrombopoetin do?

A

Stimulate production of platelets in the bone marrow

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4
Q

What are Kupffer cells?

A

Specialised macrophages in the liver

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5
Q

How does the body process alcohol?

A

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

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6
Q

How long does it take for a healthy liver to process 1 unit of alcohol?

A

1 hour

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7
Q

What happens in chronic consumption of alcohol?

A

Deposition of triglycerides in liver –> fatty liver disease

Inappropriate activation of stellate cells which produce collagen –> fibrosis and scar tissue

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8
Q

What is the recommended drinking allowance?

A

No more than 14 units spread over >3 days

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9
Q

Consuming >100 units/wk does what?

A

Puts you at 20% risk of developing serious liver disease

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10
Q

What are the majority of deaths due to alcohol due to?

A

Cirrhosis

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11
Q

What is the progression of alcohol related liver disease?

A

Normal liver –> steatosis –> hepatosteatosis –> fibrosis –> cirrhosis

Steatosis is reversible!

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12
Q

Why does alcohol consumption lead to steatosis?

A

Alcohol is calorie rich and fatty acids are produced from its metabolism - these are deposited around the CENTRAL vein and then the parenchyma

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13
Q

What are indicators of chronic alcohol use?

A 
Elevated gamma GT
Macrocytosis (enlarged RBCs)
Low platelets 
Elevated ferritin 
Enlarged, smooth edged liver on AUSS
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14
Q

What changes occur to the liver in alcoholic hepatitis?

A

Infiltration of liver with leucocytes and necrosis

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15
Q

What are the symptoms of alcoholic hepatitis?

A

Hepatomegaly, jaundice, abdominal pain, fever, hepatic decompression

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16
Q

What can you use to measure 28 day survival without treatment in alcohol hepatitis?

A

Glasgow Alcoholic Hepatitis Score

Using age, inflammation markers and LFTs

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17
Q

How do you manage alcoholic hepatitis?

A

Steroids

Manage infection, nutrition, renal impairment or coagulation problems if they arise

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18
Q

What changes occur to the liver in liver fibrosis?

A

Chronic inflammation
Stellate cells activated –> collagen production

Localised fibrosis around the vein and loss of lobule structure

19
Q

How can you assess the severity of cirrhosis?

A

Fibroscan –> less elastic = more likely to be cirrhosis

20
Q

What are the complications of cirrhosis?

A

Variceal haemorrhage
Encephalopathy
Ascites

21
Q

What cancer can occur in those with cirrhosis?

A

Hepatocellular carcinoma

22
Q

What law controls alcohol use/selling?

A

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

23
Q

What are some equivalents to 14 units?

A

6 pints of beer
6 glasses of wine
14 shots

24
Q

What are the effects of alcohol at lower doses?

A

Euphoria, increased sociability, reduced anxiety, relaxation

25
Q

What are the effects of alcohol at higher doses?

A

Intoxication

26
Q

Define intoxication

A

Pathological state induced by a drug/serum/alcohol (poisoning)

27
Q

What is the ICD-10 criteria for alcohol dependence?

A

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
28
Q

Define withdrawal state

A

Symptoms relating to the withdrawal of a substance after persistent use of that substance

29
Q

Define harmful use of alcohol

A

Pattern of use causing damage to physical/mental health (over >1 month/repeatedly over 12 months)

30
Q

What are the neurochemical effects of alcohol?

A

Depressant
Enhances inhibitory GABA A, glycine and adenosine
Reduces excitatory NDMA glutamate, aspartate
Promotes endogenous opioid release and endocannabinoid release

31
Q

What are the symptoms of alcohol withdrawal?

A

N/V, tremor, anxiety, weakness, seizures, confusion, agitation, death

32
Q

What is delirium tremens?

A

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

33
Q

What mortality is associated with delirium tremens?

A

5%

34
Q

What kinds of problems does alcohol misuse cause?

A 
Physical health 
Mental health 
Relationships 
Employment/financial 
Legal
35
Q

What is Othello syndrome?

A

Repeated episodes of jealous, accusations of infidelity, searches for evidence etc. (may be due to schizophrenia, alcohol etc.)

36
Q

What mental health problems are associated with alcohol?

A 
Anxiety
Depression 
Sleep disruption 
Morbid jealousy
Hallucinations
Self arm/suicide
37
Q

State some physical health problems with chronic alcohol use

A 
Loss of muscle
HTN
Ulcers/gastritis
Brain damage
Memory problems
Risk of chest infection 
Liver problems
Nerve problems
Infertility/impotence
38
Q

What cancers does alcohol misuse predispose to?

A

Mouth, oesophagus, liver

39
Q

What is Korsakoff’s psychosis?

A

Thiamine deficiency –> retrograde and anterograde amnesia (immediate recall okay)

May also have impaired learning/disorientation, nystagmus, ataxia

40
Q

What is Wernicke’s encephalopathy?

A

Thiamine deficiency –> ataxia, confusion, opthalmoplegia, nystagmus

41
Q

What screening tools can you use for alcohol misuse?

A

CAGE
FAST
AUDIT
PAT

42
Q

What are the 4 CAGE questions?

A

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?

43
Q

What is involved in the management of alcohol addiction?

A

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

44
Q

What medication is used for alcohol addiction?

A

Thiamine to prevent Wernicke’s/Korsakoff
Benzos (chlorodiazepoxide)
Aversion Rx - disulfiram
Anti-craving Rx - Acamprosate/naltrexone/nalmefene

psychiatry (26 decks)

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