Alcohol symposium

Question 1

Recommended amounts of alcohol intake
Male
Female
At what threshold will there be a 20% chance of developing serious liver disease

Answer 1

Male = female
14 units per week
> 100 units per week, 20% chance of developing serious liver disease

Question 2

1 unit of alcohol: (state volume)
Cider
Wine
Whiskey
Beer
Alcopop

Answer 2

Cider - 218 ml
Wine - 76ml
Whiskey - 25 ml
Beer - 250ml
Alcopop - 250ml

Question 3

Indicators of chronic alcohol use [6]
Includes 4 lab tests
1 test on AUSS

Answer 3

History AND

Lab 4

• Elevated GGT
• Elevated ferritin
• Macrocytosis
• Low platelets

AUSS - enlarged smooth edged liver

Question 4

4 stages of alcohol-related liver disease

Which stage is still reversible liver disease ie with alcohol abstinence?

Answer 4

[Normal liver]
Fatty liver/steatosis*
Steatohepatitis
Fibrosis
Liver cirrhosis

Question 5

Define steatosis pathogenesis briefly [2]

Answer 5

Alcohol > acetaldehyde > acetate > fatty acids

Fat deposited around central veins then parenchyma

Question 6

Define alcoholic hepatitis [3]

Answer 6

Fatty change within liver 
AND
Inflammation with leukocytes
RESULTING IN
hepatic necrosis

Question 7

4 clinical features of alcoholic hepatitis or steatohepatitis

Answer 7

Hepatomegaly, abdo pain
Hepatic decompensation, jaundice
Fever

Question 8

3 modes of tx for steatohepatitis

Answer 8

Steroids
Management of infection
Nutrition

Question 9

2 complications of steatohepatitis

Answer 9

Renal impairment

Coagulopathy

Question 10

Chronic inflammation of liver leads to… [3]

Answer 10

Activation of stellate cells
Increased collagen production
Fibrosis

Question 11

3 complications of cirrhosis

Answer 11

Variceal hemorrhage
Encephalopathy
Ascites

Question 12

Fibrosis vs cirrhosis [3]

Answer 12

Degree of scarring
Fibrosis - localized fibrosis around vein
Cirrhosis is pan-lobular scarring characterized by collagen bridging between veins/tracts

Question 13

Glasgow Alcoholic Hepatitis Score
What does it indicate
At what threshold does it indicate a good/bad chance of survival

Answer 13

Indicates chance of 28 day survival
If <9 indicates 87% chance
If >9, indicates 46% chance

Question 14

Diagnosis of alcohol abuse [4]

Answer 14

Acute intoxication/poisoning
Harmful use
Dependence
Withdrawal state

Question 15

4 L’s of alcohol problems

Answer 15

Health
- Physical health
- Mental health
Relationships
Employment, financial
Legal

Question 16

What is termed as harmful abuse [2]

Answer 16

Pattern of use causing damage to health

Use >1x in a month or repeatedly over 1 year

Question 17

What is termed as dependence

6 signs

Answer 17

3 or more of dependence signs for >1 month or repeatedly over 1 year

• Cravings
• Difficulty controlling use
• Primacy
• Increased tolerance
• Physiological withdrawal on cessation
• Persistence despite harmful consequences

Question 18

What are 4 features of the withdrawal state

Answer 18

Tremor, weakness
Nausea, vomiting
Anxiety, agitation
Seizures, confusion

Question 19

What are 6 features of the delirium tremens
Mortality rate?
Onset after alcohol cessation?

Answer 19

Profound confusion
Agitation
Tremor
Hallucinations, delusions
Sleeplessness
Autonomic over-activity
5% mortality rate
48-72 hours after alcohol stopped

Question 20

Causes of death in DT [4]

Answer 20

Cardiovascular collapse
Infection
Hyperthermia
Seizures
Self- injury

Question 21

Alcohol impact

Physical health [7]

Answer 21

Accidental injury
Violence
Cancer - mouth, esophagus, liver
Neurological [5]
CVS - cardiomegaly, HTN, irregular pulse
Infections - chest infx, STI, HIV/AIDS
GI
Sexual- impotence men, infertility women

Question 22

3 GI features of alcohol abuse

Answer 22

ulcers, gastritis
haematemesis
pancreatitis

Question 23

5 neurological features of alcohol abuse

Answer 23

fits, confusional state
Korsakoff's psychosis
Wernicke's encephalopathy
Brain damage, loss of memory, hallucinations, dementia
Paresthesia, tremors

Question 24

6 mental health features of alcohol abuse

Answer 24

Anxiety, depression
Sleep disruption
Morbid jealousy
Alcoholic hallucinosis
Deliberate self-injury
Suicidal ideation

Question 25

Thiamine deficiency
cause [3]
sequelae [2]

Answer 25

Alcohol abuse causes poor intake and absorption
poor hepatic function
increased thiamine requirement to metabolism alcohol
> thiamine deficiency

Wernicke’s encephalopathy
Korsakoff’s psychosis

Question 26

Wernicke’s encephalopathy

CONA [4]

Answer 26

Confusion
Opthalmegia
Nystagmus
Ataxia

Question 27

Korsakoff’s psychosis
Effect on memory [3]
2 features in Wernicke’s
2 other features

Answer 27

Effects on memory:
Prominent impairment of recent, remote memory
Preservation of immediate recall
Retrograde and anterograde amnesia

2 features same as Wernicke’s:
Nystagmus
Ataxia

2 other features:
Impaired learning
Disorientation

Question 28

CAGE Screening Tool

What are the 4 cage questions

Answer 28

Cut down
Annoyed
Guilty
Eye-opener

Question 29

Name 3 other alcohol screening tests

Answer 29

AUDIT
- Alcohol use disorder identification test
FAST
- FAST alcohol screening test
PAT
- Paddington Alcohol Test

Question 30

Management of alcohol abuse

5 aspects of psycho-social management

Answer 30

Psycho-social mx

• Education
• Social support from relationships, community support
• Psychological therapy
• Social work input
• Skills training

Question 31

Management of alcohol abuse
4 aspects of medical treatment
Name 4 anti-craving rx

Answer 31

Thiamine supplements
BDZ - chlodizepoxide
Aversion medication
Anti-craving medication
- Acamprosate
- Naltrexone
- Nalmefene
- Baclofen