Alcohol symposium

Question 1

what changes in blood results would you expect with someone with chronic alcohol consumption?

Answer 1

elevated ferritin
low platelets
macrocytosis (enlarged RBC)
elevated gamma GT

Question 2

in a patient with chronic alcohol consumption, what would expect to see on abdominal USS?

Answer 2

enlarged smooth edge liver

Question 3

what are the complications of liver decompensation?

Answer 3

encephalopathy
variceal haemorrhage
ascites

Question 4

what substances does the liver store?

Answer 4

glucose
copper
iron
vitamins

Question 5

what 2 enzymes are involved with alcohol metabolism?

Answer 5

ADH

ALDH

Question 6

what is the weekly limit of recommended alcohol?

Answer 6

< 14 units (both males and females)

Question 7

what are the risk factors for alcoholic liver disease?

Answer 7

females
genetic predisposition - fast ADH and slow ALDH
nutritional deficiency with poor dietary status
coexisting infections - hep C

Question 8

what are the causes of liver cirrhosis?

Answer 8

alcohol
hepatitis B and C
fatty liver disease
autoimmunity - autoimmune hepatitis, PBC, PSC

Question 9

how do you identify if a patient has alcoholic hepatitis?

Answer 9

FBC - leukocytosis

USS and/or biopsy - hepatic necrosis

Question 10

what is the presentation of alcoholic hepatitis?

Answer 10

abdominal pain 
jaundice 
fever
hepatomegaly 
hepatic decompensation

Question 11

what scoring system is used for classification of severity of alcoholic hepatitis?

Answer 11

glasgow alcohol hepatitis score

Question 12

at what score of the glasgow alcohol hepatitis score is treatment commenced?
what is the treatment?

Answer 12

> 9
steroids
nutrition, thiamine, management of renal impairment and coagulopathy

Question 13

what cell type is activated in liver cirrhosis?

Answer 13

stellate cells

Question 14

what is the 5 year survival of a patient with alcohol liver disease if they continue drinking and if they stop?

Answer 14

continue = 35%
abstinence = 65%

Question 15

what is alcohol dependance defined as?

Answer 15

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

Question 16

what are some of the symptoms a patient may experience from withdrawal from alcohol if they are dependent?

Answer 16

tremor
anxiety
agitation
confusion
sweats
vomiting / nausea
weakness
seizures 
death
delirium tremens

Question 17

what is delirium tremens?

Answer 17

profound confusion, tremor, delusions, hallucinations, sleeplessness and autonomic auto-activity

complication of withdrawal with a mortality rate of 5%

Question 18

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?

Answer 18

wenches encephalopathy

Question 19

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?

Answer 19

korsakoff’s psychosis

Question 20

what is the cause of korsakoff’s syndrome?

Answer 20

lack of vitamin B1 due to poor nutrition

Question 21

what screening tools are used for suspected alcohol dependence?

Answer 21

CAGE
PAT - paddington alcohol test
FAST
AUDIT - alcohol use dependent identification test

Question 22

what is involved in the CAGE screening test?

Answer 22

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

Question 23

what are some of the management required for patients who are alcoholics?

Answer 23

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

Question 24

give an example of an anticraving medication.

Answer 24

naltrexone

acamprosate

Question 25

what medication is given to treat withdrawal symptoms?

Answer 25

benzodiazepines

Question 26

what is the use of disulfiram?

Answer 26

used to increase a patients sensitivity to alcohol

Question 27

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?

Answer 27

disulfiram (antabuse)

Question 28

what is the presentation of Wernicke’s encephalopathy and what is it caused by?

Answer 28

thiamine (vitamin B1) deficiency

confusion
ophthalmoparesis (abnormal eye movements) i.e. nystagmus, double vision
ataxia