Alcohol symposium Flashcards
what changes in blood results would you expect with someone with chronic alcohol consumption?
elevated ferritin
low platelets
macrocytosis (enlarged RBC)
elevated gamma GT
in a patient with chronic alcohol consumption, what would expect to see on abdominal USS?
enlarged smooth edge liver
what are the complications of liver decompensation?
encephalopathy
variceal haemorrhage
ascites
what substances does the liver store?
glucose
copper
iron
vitamins
what 2 enzymes are involved with alcohol metabolism?
ADH
ALDH
what is the weekly limit of recommended alcohol?
< 14 units (both males and females)
what are the risk factors for alcoholic liver disease?
females
genetic predisposition - fast ADH and slow ALDH
nutritional deficiency with poor dietary status
coexisting infections - hep C
what are the causes of liver cirrhosis?
alcohol
hepatitis B and C
fatty liver disease
autoimmunity - autoimmune hepatitis, PBC, PSC
how do you identify if a patient has alcoholic hepatitis?
FBC - leukocytosis
USS and/or biopsy - hepatic necrosis
what is the presentation of alcoholic hepatitis?
abdominal pain jaundice fever hepatomegaly hepatic decompensation
what scoring system is used for classification of severity of alcoholic hepatitis?
glasgow alcohol hepatitis score
at what score of the glasgow alcohol hepatitis score is treatment commenced?
what is the treatment?
> 9
steroids
nutrition, thiamine, management of renal impairment and coagulopathy
what cell type is activated in liver cirrhosis?
stellate cells
what is the 5 year survival of a patient with alcohol liver disease if they continue drinking and if they stop?
continue = 35% abstinence = 65%
what is alcohol dependance defined as?
3 or more of the following for > 1 month or repeatedly > 12 months
- cravings
- difficulty controlling use
- primacy
- increased tolerance
- physiological withdrawal on reduction/cessation
- persistence despite harmful consequences
what are some of the symptoms a patient may experience from withdrawal from alcohol if they are dependent?
tremor anxiety agitation confusion sweats vomiting / nausea weakness seizures death delirium tremens
what is delirium tremens?
profound confusion, tremor, delusions, hallucinations, sleeplessness and autonomic auto-activity
complication of withdrawal with a mortality rate of 5%
a known alcoholic presents to the emergency department with confusion, unsteadiness and nystagmus. His wife says the unsteadiness and nystagmus has been going on for the past few days.
what do you suspect?
wenches encephalopathy
a known alcoholic attends the GP with his wife who has been getting progressively worried with his memory. she says that he cannot remember recent events but he isn’t getting confused or losing mental ability.
what do you suspect?
korsakoff’s psychosis
what is the cause of korsakoff’s syndrome?
lack of vitamin B1 due to poor nutrition
what screening tools are used for suspected alcohol dependence?
CAGE
PAT - paddington alcohol test
FAST
AUDIT - alcohol use dependent identification test
what is involved in the CAGE screening test?
have you tried to cut down?
do you get annoyed when people ask about your drinking?
do you feel guilty when you drink?
have you ever felt that you need an eye opener
what are some of the management required for patients who are alcoholics?
medical:
- thiamine
- steroids
- benzodiazepine
- anticravings i.e. acamprosate, naltrexone
- disulfiram (antabuse - makes you sick when you drink alcohol)
- CBT, motivational interviewing
nutritional
social - employment, benefits, child protection
community training - AA meetings
financial
give an example of an anticraving medication.
naltrexone
acamprosate
what medication is given to treat withdrawal symptoms?
benzodiazepines
what is the use of disulfiram?
used to increase a patients sensitivity to alcohol
a known alcoholic patient is put on a drug which makes his sick when he drinks alcohol to help with his addiction. what drug is this?
disulfiram (antabuse)
what is the presentation of Wernicke’s encephalopathy and what is it caused by?
thiamine (vitamin B1) deficiency
confusion
ophthalmoparesis (abnormal eye movements) i.e. nystagmus, double vision
ataxia
