Alcohol symposium Flashcards
Recommended amounts of alcohol intake
Male
Female
At what threshold will there be a 20% chance of developing serious liver disease
Male = female
14 units per week
> 100 units per week, 20% chance of developing serious liver disease
1 unit of alcohol: (state volume) Cider Wine Whiskey Beer Alcopop
Cider - 218 ml Wine - 76ml Whiskey - 25 ml Beer - 250ml Alcopop - 250ml
Indicators of chronic alcohol use [6]
Includes 4 lab tests
1 test on AUSS
History AND
Lab 4
- Elevated GGT
- Elevated ferritin
- Macrocytosis
- Low platelets
AUSS - enlarged smooth edged liver
4 stages of alcohol-related liver disease
Which stage is still reversible liver disease ie with alcohol abstinence?
[Normal liver] Fatty liver/steatosis* Steatohepatitis Fibrosis Liver cirrhosis
Define steatosis pathogenesis briefly [2]
Alcohol > acetaldehyde > acetate > fatty acids
Fat deposited around central veins then parenchyma
Define alcoholic hepatitis [3]
Fatty change within liver AND Inflammation with leukocytes RESULTING IN hepatic necrosis
4 clinical features of alcoholic hepatitis or steatohepatitis
Hepatomegaly, abdo pain
Hepatic decompensation, jaundice
Fever
3 modes of tx for steatohepatitis
Steroids
Management of infection
Nutrition
2 complications of steatohepatitis
Renal impairment
Coagulopathy
Chronic inflammation of liver leads to… [3]
Activation of stellate cells
Increased collagen production
Fibrosis
3 complications of cirrhosis
Variceal hemorrhage
Encephalopathy
Ascites
Fibrosis vs cirrhosis [3]
Degree of scarring
Fibrosis - localized fibrosis around vein
Cirrhosis is pan-lobular scarring characterized by collagen bridging between veins/tracts
Glasgow Alcoholic Hepatitis Score
What does it indicate
At what threshold does it indicate a good/bad chance of survival
Indicates chance of 28 day survival
If <9 indicates 87% chance
If >9, indicates 46% chance
Diagnosis of alcohol abuse [4]
Acute intoxication/poisoning
Harmful use
Dependence
Withdrawal state
4 L’s of alcohol problems
Health - Physical health - Mental health Relationships Employment, financial Legal
What is termed as harmful abuse [2]
Pattern of use causing damage to health
Use >1x in a month or repeatedly over 1 year
What is termed as dependence
6 signs
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
What are 4 features of the withdrawal state
Tremor, weakness
Nausea, vomiting
Anxiety, agitation
Seizures, confusion
What are 6 features of the delirium tremens
Mortality rate?
Onset after alcohol cessation?
Profound confusion Agitation Tremor Hallucinations, delusions Sleeplessness Autonomic over-activity 5% mortality rate 48-72 hours after alcohol stopped
Causes of death in DT [4]
Cardiovascular collapse Infection Hyperthermia Seizures Self- injury
Alcohol impact
Physical health [7]
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
3 GI features of alcohol abuse
ulcers, gastritis
haematemesis
pancreatitis
5 neurological features of alcohol abuse
fits, confusional state Korsakoff's psychosis Wernicke's encephalopathy Brain damage, loss of memory, hallucinations, dementia Paresthesia, tremors
6 mental health features of alcohol abuse
Anxiety, depression Sleep disruption Morbid jealousy Alcoholic hallucinosis Deliberate self-injury Suicidal ideation
Thiamine deficiency
cause [3]
sequelae [2]
Alcohol abuse causes poor intake and absorption
poor hepatic function
increased thiamine requirement to metabolism alcohol
> thiamine deficiency
Wernicke’s encephalopathy
Korsakoff’s psychosis
Wernicke’s encephalopathy
CONA [4]
Confusion
Opthalmegia
Nystagmus
Ataxia
Korsakoff’s psychosis
Effect on memory [3]
2 features in Wernicke’s
2 other features
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
CAGE Screening Tool
What are the 4 cage questions
Cut down
Annoyed
Guilty
Eye-opener
Name 3 other alcohol screening tests
AUDIT - Alcohol use disorder identification test FAST - FAST alcohol screening test PAT - Paddington Alcohol Test
Management of alcohol abuse
5 aspects of psycho-social management
Psycho-social mx
- Education
- Social support from relationships, community support
- Psychological therapy
- Social work input
- Skills training
Management of alcohol abuse
4 aspects of medical treatment
Name 4 anti-craving rx
Thiamine supplements BDZ - chlodizepoxide Aversion medication Anti-craving medication - Acamprosate - Naltrexone - Nalmefene - Baclofen
