Alcohol Misuse Flashcards
What are the 6 criteria for alcohol dependence
- Cravings/compulsions to take
- Difficulty controlling use/loss of control
- Primacy/takes priority
- Increased tolerance
- Physiological withdrawal on reduction/cessation
- Persistence despite harmful consequences
For how many and how long do the 6 criteria need to persist to diagnose dependence of alcohol
3 or more of the criteria
For >1month
Or
Repeatedly over 12 months
Describe clinical features of withdrawal
Tremor Weakness Nausea Vomiting Anxiety Seizures Confusion, Agitation Death
Screening tools for Alcohol addiction
CAGE
FAST
AUDIT
PAT
Describe the CAGE screening tool
CAGE (2 or more = likely alcohol problem)
Have you tried to Cut down?
Have you felt Annoyed by people criticising your drinking?
Have you felt Guilty about drinking?
Have you felt the need to have an Eye-opener?
Which screening tool is often used by GPs
FAST
Triad of Wernicke’s Encephalopathy
Confusion
Ataxia
Opthalmoplegia (e.g nystagmus)
What is the cause of Wernicke’s Encephalopathy
Thiamine deficiency
Alcohol Hx questions to ask
Type Units Has this increased How long Pattern of drinking (typical day)
Prevention of Encephalopathy Rx
Thiamine
Rx for Wernicke’s Encephalopathy
IV Thiamine
Rx for withdrawal
Benzodiazepines (Chlordiazepoxide)
Which aversion/deterrent medication can be given as Rx
Disulfiram (Antabuse)
What is the action of aversion/deterrent medication
Means if the patient drinks alcohol having taken this medication they will feel awful
Which anti-craving medication can be given as Rx
Acamprosate (Campral)
Naltrexone
Nalmefene (Baclofen)
Psycho-social approach for alcohol addiction recovery
Support for patient and family
Psychological help (e.g. CBT, group therapy)
Social work input (benefits, housing, child protection)
Skills training
Community Support (eg AA, ADA)
Inpatient or residential treatment
What is delirium tremens
Profound acute confusion
48-72hrs after alcohol is withdrawn
Admit
Symptoms of delirium tremens
Tremors Agitation Hallucinations Delusions Sleeplessness Autonomic over activity
Effects of higher disease of alcohol
Intoxication Impaired attention and judgement Unsteadiness Flushing Nystagmus Mood instability Disinhibition Slurring Stupor Unconsciousness
Effects of low doses of alcohol
Euphoria
anxiety
Relaxation
Sociability
Effects of alcohol on mental health
Anxiety Depression Sleep disturbance Morbid jealousy Alcoholic hallucinosis Deliberate self-injuryy Suicidal thoughts/acts
Effects of alcohol on the brain
Brain damage Loss of memory Hallucinations Fits Dementia
Effects of alcohol on the chest
Risk of chest infection
Effects of alcohol on the liver
Swollen liver
Hepatitis
Cirrhosis
Effects of alcohol on the nervous system
Paraesthesia
Numbness
Trembling hands
Effects of alcohol on the risks of STI
HIV and AIDS
Effects of alcohol on the endocrine system
Poro control DM
Effects of alcohol on the GI system
Ulcers
Gastritis
Haematemsis
Pancreatitis
Effects of alcohol on sexual system
Impotence in men
Infertility in women
How many units of alcohol does a healthy liver process in 1hr
1 unit per 1hr
What is the recommended drinking units for M and F
both M and F
14 units
What is alcoholic fatty liver
When fat is deposited in and around the liver
What are the potential outcomes of alcoholic fatty liver
Reversible
Can become inflamed steatohepatitis
Can develop cirrhosis
Which score is used to measure alcoholic hepatitis
Glasgow Alcoholic Hepaittis Scroe
What does a GAHs score > 9 indicate with 30 day mortality
30 day mortality
Without steroids = 48%
With steroids = 22%
What does a GAHs score >9 indicate with 84 day mortality
Without steroids - 62%
Within steroids - 41%
What is the toxic product of alcohol breakdown
Acetaldehyde
What happens to acetaldehyde in alcohol problems
There is an overload/increased amount causing harm
Signs of chronic liver disease
Spider naevi Palmar erythema Gynaecomastia Loss of axillary and pubic hair Ascites Encephalopathy Jaundice
What does a raised GTT often relate to
Alcohol
What causes hepatic encephalopathy
High levels of ammonia built up in the system
Crosses the BBB
How is hepatic encephalopathy graded
1-4
1 = mild confusion
4 = coma
Rx for alcoholic hepatitis
Steroids
Management of infection
Nutrition
ABSTINENCE
What is the first stage of alcohol related liver disease
Fatty liver
Steatosis
Is fatty liver disease reversible
yes with abstinence
Rx for hepatocellular cancer
Surgical resection
Liver Tx
Radiofrequency/microwave ablation
Chemotherapy
What is the most common reason for liver Tx in Scotland
Alcohol related liver disease
