Alcohol - the clinicians perspective

Question 1

What are the symptoms of mild alcohol withdrawel?

Answer 1

Fine tremor
Sweating
Anxiety
Hyperactivity
Tachycardia
Hypertension 
Anorexia
Nausea
Retching

Question 2

What are the symptoms of moderate alcohol withdrawel?

Answer 2

Coarse tremor
Shaking
Agitation
Confusion 
Disorientation 
Paranoia
Seizures
Hallucinations

Question 3

What are the symptoms of severe alcohol withdrawl?

Answer 3

Severe agitation 
Anxiety 
Confusion 
Tactile visual hallucinations 
Circulatory collapse and death

Question 4

What type of seizure is an alcohol withdrawal seizure?

Answer 4

Generalised tonic clonic seizure

Clustered over a few hours

Question 5

What is peripheral neuropathy?

Answer 5

Sensorimotor axonal polyneuropathy

Causes burning, pain and weakness

Question 6

What is compression neuropathy?

Answer 6

Temporary damage to myelin sheath (saturday night palsy)

Radial nerve compression at humeral head

Question 7

What sort of myopathy can occur after an acute binge?

Answer 7

Myalgia, proximal weakness, swollen tender muscles due to a raised CK

Question 8

What sort of myopathy can occur with chronic alcoholism?

Answer 8

Painless, proximal weakness and atrophy, normal CK, low K and PO4

Question 9

What is wernikes encephalopathy?

Answer 9

Thiamine deficiency and cytotoxic oedema in mamillary bodies

Question 10

What is the triad of wenickes encephalopathy?

Answer 10

Occular dysfunction (nystagmus and opthalmoparesis)
Ataxic gait
Acute confusion

Question 11

What is korsakoff syndrome?

Answer 11

Cerebral atrophy resulting from WE

Question 12

What are the symptoms of korsakoff syndrome?

Answer 12

Anterograde amnesia
Confabulation
Lack of insight
Abstinence and nutrition for treatment

Question 13

How does chronic alcoholism cause cardiomyopathy?

Answer 13

Impaires ventricular function (calcium homeostasis, mitochrondrial effects, signal transduction)
Prolonged exposure leads to chronic inflammation/ fibrosis of myofibrils

Question 14

What arrhythmias can occur with acute alcohol intoxication?

Answer 14

AF, SVT (holiday heart)

Question 15

What arrhythmias can occur with chronic alcohol intoxication?

Answer 15

Electrolyte imbalance can lead to a long QT

Dilated cardiomyopathy can lead to atrial and ventricular arrhythmias

Question 16

What is the pathogenesis for regular heavy drinking?

Answer 16

Fat accumulation in hepatocytes
Inflammation
Fibrosis
Cirrhosis

Question 17

What is alcohol related hepatits?

Answer 17

Acute, lifethreatning manifestation
Parenchymal inflammation and hepatocyte damage
Jaundice, coagulopathy and liver failure

Question 18

What is the pathogenesis for alcohol related cirrhosis?

Answer 18

Progressive fibrosis
Architectural distortion
Cirrhosis
Portal hypertension

Question 19

What is compensated alcohol related cirrhosis?

Answer 19

Compensated - normal liver function and normal physical function

Question 20

What is decompensaed alcohol related cirrhosis?

Answer 20

Impaired synthetic function, ascited and encephalopathy

Question 21

What are the treatments for alcohol cirrhosis?

Answer 21

Abstinence
Vitamins
Nutrition
Endoscopic
Pharma - Bblockers, lactulose, rifaximin
Radiological - TIPPS
Surigcal - transplant

Question 22

What is a brief intervention?

Answer 22

Feedback on person’s alcohol use and any related harm
Clarification as to what constitutes low risk consumption
Info on harms associated with risk alcohol use
Benefits of reducing intake

Question 23

What are the pharmacological interventions that can reduce alcohol consumption?

Answer 23

Acamprosate - reduces cravings
Naltrexone - reduces desire for alcohol
Disulfiram - aversion therapy drug - produces a similar reaction of metrondiazole with alcohol
Nalmefene - opioid antagonist