alcohol symposium Flashcards
1
Q
what is the CMO guidance for alcohol consumption? 3
A
- low risk: less than 14 units a week, spread over 3 or more days
- Increased risk: men 14-50 units a week, women 14-35 units a week
- High risk: men over 50 units a week, women over 35 units a week, risk or alcohol related problems
2
Q
what are the proportions of people who drink in Brighton and Hove? 2
A
- 1/5 adults drink over 14 units of alcohol nationally
- 2/5 in Brighton and Hove
3
Q
what factors are associated with children having a drink in the last week? 7
A
- Parents don’t discourage drinking
- Older pupils
- Recent drug use
- Drinkers at home
- Smoking
- White ethnicity
- Playing truant
4
Q
describe the statistics for children in Brighton and Hove? 5
A
- 73% of 15 year olds in the UK have drunk alcohol
- 15% of 11 year olds
- 11% of 15 years olds in Brighton and Hove drink regularly
-24% of 15-year-olds in Brighton and Hove have tried cannabis
5
Q
describe the statistics around death with alcohol? 6
A
- Alcohol misuse is the biggest factor for early death in England in adults under 50
- It can lead to cardiovascular disease, liver disease and more
- Globally there are 2.5 million deaths a year, 5.1% of the global burden of disease and injury is attributable to alcohol
- 1/3 cases of domestic violence are alcohol related
- 1/7 RTA are due to alcohol
- 1/5 of all calls to ChildLine are related to parents’ alcohol consumption
6
Q
who can influence alcohol consumption? 7
A
- Individual factors
- Family
- Culture and community
- Socioeconomics
- Religion
- Country/laws
- Taxes
7
Q
name some policies to limit consumption and reduce harm? 2
A
- Taxation to limit affordability and raise revenue
- Regulation and legislation- alcohol promotion and marketing, price, drink driving
8
Q
describe minimum unit pricing? 4
A
- 50p minimum price per unit
- Increases the price of cheap high alcohol drinks
- Reduces harm
- Not a tax
9
Q
describe sensible on strength? 7
A
- Licensed businesses voluntarily stop selling super strength beer, lager and cider about 6% refusals systems, CCTV, documented training
- Tackle anti-social behaviours
- Improve health for vulnerable drinkers
- Identify problem areas in the city
- Reduces crime and disorder
- Reduced intimidation and violence to staff
- Not an anti-alcohol scheme
10
Q
describe views on drinking with different cultures? 2
A
- In wet drinking cultures, there is integration of alcohol into daily life, as a consumer commodity like any other
- In dry drinking cultures, alcohol is marginalised as an especially powerful and hazardous commodity
11
Q
why do people drink? 4
A
- Various reasons
- Enhancement- to feel better, to do things otherwise impossible
- Social- to be sociable, to celebrate parties
- Conformity- because other do, to fit in coping- because it helps you forget about problems
12
Q
why don’t some people drink? 5
A
- Short term harm= alcohol poisoning, accidents and injury, violence, antisocial behaviours
- Long term harm= cirrhosis, cancers, stroke, premature death and suicide
- Hangovers
- Aldehyde dehydrogenase 2 (ALDH-2) deficiency
- Religion/ culture
13
Q
can we change how people drink? 2
A
- Efforts must focus on motives for drinking and not drinking
- Messages may be gained-framed or loss-framed
14
Q
what do people need to adhere to guidelines? 3
A
- Information= be exposed to and understand the guidelines
- Motivation= consider the guidelines to be meaningful/ relevant
- Behavioural skills= know how to apply the guidelines to own behaviour
15
Q
describe awareness/ screening/ brief intervention? 5
A
- People tend to have poor knowledge and lack the requisite skills
- Personalised feedback on drink pouring:
- Improved knowledge
- Enhances behavioural skills
- Reduces alcohol intake
16
Q
describe the outcomes of dry January? 3
A
- Abstinence challenges allows people to perform behavioural experiments, boot motivation and enhance behavioural skills
- Benefits of not drinking- majority report better sleep, concentration, saving money and a minority report weight loss
- Enduring effects- 40% drink less 6 months later and have a greater sense of control over drinking
17
Q
why is a psychosocial approach required? 5
A
- Qualitative studies show the importance of social context and social factors
- Interventions and attempts to motivate people must acknowledge this
- Concerns about health
- Concerns about fitting in
- Concerns about reputation, image, weight
18
Q
what is alcohol dehydrogenase polymorphism? 2
A
- Several isoforms of this enzyme are present, with variable activity in individuals depending on genetic makeup and other factors
- Individuals of Asian descent who have the B2 ADH isoform, metabolise ethanol 20% faster than northern Europeans who possess the B1 ADH
19
Q
describe the effect of alcohol dehydrogenase polymorphism on the redox state? 3
A
- Both alcohol dehydrogenase and aldehyde dehydrogenase reactions reduce NAD to NADH
- Increases= lactate: pyruvate ratio, beta-hydroxybutyrate: acetoacetate ratio
- Inhibits: glycolysis, citric acid cycle (ketogenesis), fatty acid production, gluconeogenesis
20
Q
describe the toxic and metabolic effects of alcohol dehydrogenase polymorphism? 2
A
- Oxidant stress= lipid peroxidation which is associated with acute tissue damage and fibrosis
- Free radicals attack cellular and mitochondrial DNA causing deletions and mutations
21
Q
describe methanol metabolism? 7
A
- methanol \+alcohol dehydrogensase -formaldehyde \+aldehyde dehydrogenase - formic acid \+ folate - Co2 + H2O
22
Q
describe ethylene glycol (antifreeze) poisoning? 8
A
- ethylkene glycol \+alcohol dehydrogenase - glycoaldehyde \+ aldehyde dehydrogenase - glycolic acid \+lactate dehydrogenase and glycolic acid oxidase - glyoxylic acid - glycine, oxalate acid, formic acid, alpha-hydroxy-beta-ketoadipate
23
Q
what is one unit of alcohol?
A
10ml or 8g of pure alcohol
24
Q
describe ethanol and driving? 5
A
- Legal limit for driving in the UK is blood ethanol <80mg/dl
- <2-3 units in females
- <3-4 units in men
- Drinking any alcohol can still be too much if you are going to drive, operate machinery, swim or do strenuous physical activity
- Pregnant women or women trying to conceive should not drink alcohol as ethanol crosses the placenta and alcohol can seriously affect foetal development (foetal alcohol syndrome)
25
Q
what is alcoholic ketoacidosis? 6
A
- Metabolic acidosis with increased anion gap
- Typically occurs in chronic alcoholics who binge with little nutrition intake:Pathophysiology:
- glycogen depletion/ inhibited gluconeogenesis
- lipolysis and ketones increased (beta hydroxybutyrate)
- insulin suppressed
- extracellular volumes depletion/ dehydration/ stress- increase counter regulatory hormones further supressing insulin
26
Q
describe hypoglycaemia? 6
A
- ethanol causes hypoglycaemia through:
- decreased intake of glucose (CHO)
- depletion of glycogen
- blockade of gluconeogenesis
- .
- Prompt treatment with glucose is lifesaving
- Need to give parenteral thiamine as well to prevent CNS damage in case there is also thiamine deficiency
27
Q
name some typical liver function tests? 4
A
- Gamma glutamyl transferase (GGT) increased by liver enzyme function
- Transaminases (ALT and AST) increased by hepatocellular damage
- Globulin increased in cirrhosis
- Bilirubin and INR increased, and albumin decreased by liver failure
28
Q
what can cause a thiamine deficiency? 3
A
- Ethanol interferes with Gi absorption
- Hepatic dysfunction, which hinders storage and activation
- Malnourishment
29
Q
name some other relevant blood tests for alcohol related issues? 5
A
- Macrocytosis- raised MCV in a full blood count
- Raised serum ferritin concentration
- Hyperuricaemia
- Hypertriglyceridemia
- Increased carbohydrate-deficient transferrin of CDT
30
Q
describe alcohol and hypertension? 6
A
- Impairment of the baroreceptors (which sense blood pressure)
- Increase of sympathetic activity
- Stimulation of the renin-angiotensin-aldosterone system
- An increase in plasma control
- An increase of intracellular calcium with subsequent increase in vascular reactivity
- Endothelial (inhibition of endothelium-dependent nitric oxide production
31
Q
why do we do liver biopsies? 9
A
- To make a diagnosis
- Stage and grade the disease
- To monitor treatment
- To inform prognosis
- Increased risk of progression
- Micro vesicular fatty change
- Extend of fibrosis
- Amount of MD bodies
- Intrahepatic cholestasis
32
Q
describe the symptoms of alcoholic liver disease? 12
A
- Steatosis.
- Macrovesicular
- Microvesicular
- .
- Steatohepatitis;
- Ballooning of hepatocytes
- Inflammation of neutrophils
- Necrosis of hepatocytes
- Mallory denk bodies
- .
- Fibrosis/ cirrhosis
- Inflammation and necrosis cause an increase in cytokines and growth factors (TGF-beta, MCP-1) that activate fibroblasts/ myofibroblasts to deposit collagen (disse’s space)
- Cellular fibrosis- reversible
- Septal fibrosis- increasingly irreversible
33
Q
portal hypertension consequences? 8
A
- Impaired intestinal function and malabsorption
- Splenomegaly with anaemia and thrombocytopaenia
- Portal bypass circulations:
- Haemorrhoids
- Caput medusae
- Oesophageal veins
- .
- Vasodilation and compensatory increase in cardiac output
- Toxic metabolites (NH3, fatty acids, biogenic amines) bypass the liver and may cause portosystemic (hepatic) encephalopathy
34
Q
describe alcohol withdrawal? 3
A
- Physiological dependence
- The need to drink to avoid unpleasant symptoms- relief drinking
- Delirium tremens
35
Q
what are the symptoms of alcohol withdrawal? 7
A
- Tremor/shaki
- Sweating
- Tachycardia
- Nausea
- Agitation
- Seizures
- Visual hallu
36
Q
describe planned and unplanned alcohol withdrawal? 4
A
Planned:
- In community
- In hospital/ detox facility
Unplanned:
- Known alcohol problems and another medical problem
- Alcohol history not known in patient presenting with a separate problem
37
Q
describe alcohol withdrawal managements? 2
describe the potential hazards of management? 4
A
- Chlordiazepoxide- used at RSCH and PRH
- Diazepam
Potential hazards of management:
- Severe liver disease- precipitation of hepatic encephalopathy
- Respiratory depression
- Reluctance to prescribe more
- Concomitant alcohol consumption
38
Q
what is delirium? 8
A
- Disturbances of consciousness
- Change in cognition or a perceptual disturbance (hallucination)
- Tendency to fluctuate
- Behaviour overactive or underactive
- Disorganised thinking
- Poor memory
- Delusions
- Mood lability
39
Q
name some other causes of delirium? 12
A
- Any infection
- Drug side effect
- Hypoxia
- Drug overdose
- Alcohol intoxication
- Wernicke encephalopathy
- Hypoglycaemia
- Meningitis/ encephalitis
- Psychiatric illness
- Head injury
- Constipation
- Hepatic encephalopathy
40
Q
describe Wernicke’s encephalopathy? 2
A
- Brain damaged: multiple small haemorrhages especially in upper brainstem, hypothalamus and thalamus, mamillary bodies
- 20% mortality if untreated
41
Q
describe Korsakoff’s psychosis? 3
A
- Permanent brain damage
- Sever short term memory loss
- Confabulation
42
Q
what is the importance of thiamine?
A
- Confusion
- Eye signs
- Ataxia
- Only seen in 10% of cases
- Underdiagnosed
43
Q
describe Wernicke-Korsakoff syndrome? 4
A
- Can be precipitated and rapidly worsened with introduction of nutrition or administration of IV 5% dextrose
- Any available thiamine in the brain is utilised in the metabolism of glucose leading to sudden complete deficiency
- Give parenteral thiamine before dextrose of nutrition
- Always check glucose level first
44
Q
what is the treatment for Wernicke-Korsakoff syndrome? 4
A
- PABRINEX= thiamine 250mg and others
- Give IV for 25 days depending on response
- Rarely causes anaphylaxis
- Continue oral thiamine and other vitamins after initial treatment
45
Q
describe thiamine? 3
coenzyme? 3
causes of deficiency? 3
A
- Vitamin B1
- Wheat, yeast, nuts, oatmeal, potatoes, pork, marmite
- Deficiency starts a month after a thiamine free diet
Co-enzyme:
- Glucose and lipid metabolism
- Production of amino acids
- Production of glucose derived neurotransmitters
Causes of thiamine deficiency:
- Alcoholism is the commonest cause
- Chronic vomiting
- famine
