Alcohol Symposium Flashcards
what % of alcoholic fatty livers will progress to cirrhosis?
- most heavy drinkers will have fatty liver
- 20% progress to cirrhosis
- alcohol abstinence improves fatty liver to normal
Acute Alcoholic Hepatitis features
- alcohol intake > 8 units/day
- jaundice with bilirubin > 80mg/dl
- no other aetiology for liver inflammation
- very high mortality/no specific treatment yet
what scoring system is used to predict mortality in patients with alcoholic hepatitis?
Glasgow Alcoholic Hepatitis Score (GAHS)
- a score of 9 or more indicates patients most at risk of death.
how does being an alcoholic link with malnutrition?
60% of chronic abusers have malnutrition
- most of the calories is from alcohol
- total energy intake is reduced: nausea and vomiting, abdo pain, diarrhoea
how does alcoholic cirrhosis cause death?
75% die of liver decompensation
20-25% hepatocellular cancer sequelae
what is the most common indication for liver transplantation?
alcohol related liver disease
what are some complications of alcohol withdrawal?
- shaking and tembling: signify 1st and most common stage of alcohol withdrawal. Often accompanied by autonomic symptoms e.g. anxiety, rapid pule, excessive sweating etc.
- delirium tremens- occurs when the brain simply cannot deal with the sudden absence of alcohol and vital functions and organs such as heart and lungs, blood pressure, breathing and temp are severely compromised. Will experience state of confusion, hallucinations, shaking/tremors.
- hallucinations
- alcohol withdrawal seizures
- Wernicke encephalopathy
Wernicke Encephalopathy symptoms
A medical emergency!!
- eyes > jerky movements, double vision or drooping eyelids
- balance > such as when trying to stand
- movement > such as difficulty walking normally
- mind > such as feeling irritable, disoriented, drowsy, delirious or confused
what is the treatment of alcohol withdrawal?
- Individuals with severe dependence should undergo withdrawal in an inpatient setting. Patients with decompensated liver disease should be treated under specialist supervision.
- A long-acting benzodiazepine, such aschlordiazepoxide, is recommended to attenuate alcohol withdrawal symptoms.
- A symptom-triggered approach involves tailoring the drug regimen according to the severity of withdrawal and any complications in an individual patient; adequate monitoring facilities should be available. The patient should be monitored on a regular basis and treatment only continued as long as there are withdrawal symptoms.
alcohol use disorder epidemiology
- a common psychiatric disorder with lifetime prevalence estimates of 7% to 10% in most Western countries.
- men/women ratio of more than 2 to 1 (female alcoholism is probably under-reported)
- approx 8% of all patients admitted to hospital are at risk of alcohol withdrawal
define hazardous drinking
- A pattern of alcohol consumption that increases the risk of harmful consequences for the user. It is not a diagnostic term.
- drinking more than 14 units a week, but less than 35 units a week for women.
- drinking more than 14 units a week, but less than 50 units for men.
define harmful drinking
A pattern of alcohol consumption that is causing mental or physical damage.
- drinking 35+ units a week for women.
- drinking 50+ units a week for men.
define alcohol dependence
A cluster of behavioural, cognitive and psychological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use.
what is the DSM 5 criteria for alcohol use disorder?
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 or more of the following criteria, occuring at any time in the same 12 month period:
- impaired control
- social impairment; work, school, home life etc.
- risky use
- pharmacological criteria: tolerance and withdrawal.
define alcohol tolerance
- a need for markedly increased amounts of alcohol to achieve intoxicaton or desired effect.
- a markedly diminished effect with continued use of the same amount of alcohol.
