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The liver and regulation of metabolism > Alcohol symposium > Flashcards

Alcohol symposium Flashcards

1
Q

Define alcohol

A

“Alcohol” is non-specific, and includes methanol, ethanol, propanol etc.

In usual parlance, however, alcohol often means ethanol.

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2
Q

Name two enzymes involved in the metabolism of alcohol

A

Alcohol dehydrogenase

Aldehyde dehydrogenase

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3
Q

What is ethanol metabolised to?

A

Acetate

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4
Q

What can happen if you drink methanol?

A

Can become blind since when metabolised by the same enzymes in same way of ethanol to form formic acid

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5
Q

Describe the redox alteration caused by alcohol

A

Stimulates fatty acid synthesis, which are then esterified with glycerol and stored as triglyceride
NADH interferes with gluconeogenesis

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6
Q

Describe the oxidant stress alcohol causes

A

Lipid peroxidation which is associated with both acute tissue damage & fibrosis
Free radicals attack cellular & mitochondrial DNA causing deletions & mutations

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7
Q

What is 1 unit?

A

1 Unit = 10mL or 8g of pure alcohol

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8
Q

What is the current national limit for alcohol a week?

A

14 units

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9
Q

What is the current limit for driving and alcohol?

A

≤ 2-3 units in females

≤ 3-4 units in men

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10
Q

Describe alcoholic ketoacidosis

A

Metabolic acidosis with increased anion gap.

Chronic alcoholics, binge with little nutrition intake & with persistent vomiting which might cause metabolic alkalosis.

Pathophysiology :  
Extracellular volume depletion
Glycogen depletion
Increased NADH/NAD ratio
Insulin suppressed
Lipolysis and ketones increased (beta hydroxybutyrate)
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11
Q

How can ethanol cause hypoglycaemia? State the treatment of this

A

Ethanol causes hypoglycaemia through:
decreased intake of glucose (CHO),
depletion of glycogen,
blockade of gluconeogenesis

Prompt treatment with glucose is life-saving

Need to give parenteral thiamine as well to prevent CNS damage in case there is also thiamine deficiency

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12
Q

List the endocrine effects of alcohol

A

Decreased testosterone (testicular atrophy)

Pseudo Cushings

Metabolic Syndrome and Dyslipidaemia

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13
Q

List some general nutrition issues caused by ethanol

A

Low calcium (diet, decreased vitamin D)

Low phosphate (diet, increased PTH)

Low Mg, K (diet, hyperaldosteronism)

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14
Q

Can alcohol cause hypertension?

A

Yes but mechanism not clearly understood

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15
Q

How does alcohol cause thiamine deficiency?

A

Ethanol interferes with GI absorption

Hepatic dysfunction, which hinders storage and activation

Malnourishment

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16
Q

List some functions of the liver

A 
Fat metabolism 
Carbohydrate metabolism 
Protein metabolism  
Storage 
Intermediate metabolism 
Secretion
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17
Q

List some hepatic responses to injury

A

INFLAMMATION
CELL DEATH
REGENERATION
FIBROSIS (SCARRING)

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18
Q

What can excessive alcohol intake cause?

A

Fatty liver (steatosis) - early, reversible
Alcoholic (steato-) hepatitis with chronic abuse, reversible
Fibrosis (scarring)
CIRRHOSIS

19
Q

List the complications of cirrhosis

A

PROGRESSIVE LIVER FAILURE

HEPATOCELLULAR CARCINOMA

PORTAL HYPERTENSION

20
Q

What is liver failure?

A

REDUCED HEPATOCYTE FUNCTION
Decreased protein synthesis
Decreased detoxification

21
Q

What is portal hypertension?

A

ASCITES
CONGESTIVE SPLENOMEGALY
HEPATIC ENCEPHALOPATHY
PORTOSYSTEMIC SHUNTS

22
Q

Which approaches are likely to be the most effective for reducing alcohol-related harm at the population level?

A

Targeting high-risk individuals
Genetic predisposition
Family history
Earlier drinkers

23
Q

Describe the information, motivation, behavioural model

A

If people are to adhere to guidelines then they must have:

information - be exposed to and understand the guidelines
motivation - consider the guidelines to be meaningful / relevant
behavioural skills - know how to the apply guidelines to own behaviour

24
Q

What is the purpose of personalised feedback?

A 
personalised feedback does help to improve
	information
	motivation
	behavioural skills 						
… but it is resource intensive
25
Q

What is good about dry january?

A

Abstinence challenges allow people to

  • perform “behavioural experiments”
  • boost motivation
  • enhance behavioural skills
  • may have longer-lasting effects
  • encourage discussions / “change the conversation” about alcohol
26
Q

Why is a psychosocial approach required?

A

qualitative (and quantitative) studies show the importance of social context and social factors
+ behavioural experiments

interventions and attempts to motivate people must acknowledge this
? concerns about health
? concerns about fitting in
? concerns about reputation, image, weight, etc.

benefits of change - message framing

27
Q

In terms of earnings who is (a) more likely to drink and (b) more likely to be admitted to hospital as a result of alcohol?

A

(a) high earners

(b) those from a deprived population

28
Q

Describe the drinking habits of young people

A

Less likely to drink but when they do they drink more heavily

29
Q

Describe the relationship between alcohol and violence

A

Domestic violence - 1/3 alcohol related

RTAs – 1 in 7 of those killed on UK roads

Impact on children – collateral – 1/5 of all calls to Childline are related to parents alcohol consumption

30
Q

How is consumption estimated?

A
  1. Reported consumption: population surveys – e.g. Health Survey of England, Safe and well Schools Survey
  2. Taxation data from HMRC

Consistently underestimated by 40 - 60%
One third of UK population are drinking above hazardous levels

31
Q

Give examples of policies to reduce consumption and limit harm

A

Minimum Unit pricing
Sensible on strength
Cumulative impact zone

32
Q

What is alcohol withdrawal?

A

Physiological dependence

The ‘need’ to drink to avoid unpleasant symptoms - ‘Relief Drinking’

Delirium Tremens

33
Q

List some symptoms of alcohol withdrawal

A 
Tremor/shaking
Sweating
Tachycardia
Nausea
Agitation
Siezures
Visual hallucinations
34
Q

Describe the difference between planned and unplanned alcohol withdrawal

A

Planned:
- in community
- in hospital
Unplanned:
- known alcohol problems + another
medical problem
- alcohol history not known in patient
presenting with a separate problem

35
Q

When do the symptoms of alcohol withdrawal appear after admission?

A

Often occurs 2-3 days after admission

36
Q

Which drugs are used to manage alcohol withdrawal?

A

DIAZEPAM: e.g. 10-20mg qds with reducing dose over 5-10 days

CHLORDIAZEPOXIDE

37
Q

List some potential hazards of managing alcohol withdrawal

A

Severe liver disease - precipitation of hepatic encephalopathy
Respiratory depression
Reluctance to prescribe more
Concomitant alcohol consumption

38
Q

Describe delirium

A

Disturbance of consciousness
Change in cognition or a perceptual disturbance (hallucination)
Onset of hours to days, and tendency to fluctuate.
Behaviour overactive or underactive; sleep often disturbed, loss of normal circadian rhythm.
Other features include: disorganized thinking, poor memory, delusions and mood lability

39
Q

What is the importance of thiamine (vitamin B 1)?

A

Glucose and lipid metabolism
Production of amino acids
Production of glucose derived neurotransmitters

40
Q

How is thiamine deficiency caused?

A

Alcoholism
Excessive vomiting
Famine

41
Q

What is Wernicke’s Encephalopathy? State the signs

A

Brain damage:
Multiple small haemorrhages especially in upper brainstem, hypothalamus and thalamus, mamillary bodies
Signs include confusion, eye signs and ataxia

42
Q

What is Korsakoff’s Psychosis?

A

Permanent brain damage

Severe short term memory loss

Confabulation

43
Q

Describe how people become alcohol dependant and why they experience withdrawal symptoms

A

Symptoms of alcohol withdrawal occur because alcohol is a central nervous system depressant. Alcohol simultaneously enhances inhibitory tone and inhibits excitatory tone. Only the constant presence of ethanol preserves homeostasis. Abrupt cessation unmasks the adaptive responses to chronic ethanol use resulting in over activity of the central nervous system.

If you drink a lot, for a long time, your central nervous system adapts by working harder to maintain equilibrium.

If you then suddenly stop drinking, it continues to overwork which gives rise to withdrawal symptoms.

44
Q

Describe how a non medical detox works

A
  • Planned reduction
  • Drink diaries
  • Stabilisation
  • Gradually reduce (5 units per day?)
  • Consider form of alcohol, strength and size of ‘vessel’
  • Which drinks to not have? (e.g. start later, await withdrawal symptoms, plan day)

The liver and regulation of metabolism (15 decks)

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