Alcohol & the Liver

Question 1

How does alcohol cause neurological effects?

Answer 1

it interacts with the lipid bilayer of neurons and makes it leak sodium and potassium depressing the activity of neurons

Question 2

What are the alcoholic signs?

Answer 2

neurological disturbances, jaundice, altered breath, oesophageal varices, feminisation, extensively scarred liver, portal hypertension, enlarged collateral vessels, ascites, hand tremor, hypogonadism, easy bruisability, muscle wasting, oedema, infertility in women, impotence in men

Question 3

What are the different types of alcohol induced liver damage?

Answer 3

fatty liver, alcoholic hepatitis and cirrhosis

Question 4

Is fatty liver reversible?

Answer 4

yes

Question 5

What percentage of liver functioning hepatocytes are required for normal liver function?

Answer 5

40%

Question 6

What percentage of alcohol enters blood from the stomach?

Answer 6

30%

Question 7

Is alcohol metabolised in the stomach?

Answer 7

a little bit - there is some alcohol to dehydrogenase in gastric mucosa - more in males than females

Question 8

What slows alcohol absorption in the stomach?

Answer 8

fat in food

Question 9

What enzyme converts ethanol to acetaldehyde?

Answer 9

alcohol dehydrogenase

Question 10

What is a biproduct of this reaction?

Answer 10

NADH

Question 11

What is the result of the increase in NADH?

Answer 11

represses gluconeogenesis and leads to hypoglycaemia

Question 12

How else can ethanol be converted to acetaldehyde?

Answer 12

CYP2E1 metabolism

Question 13

How do you develop tolerance to alcohol?

Answer 13

upregulating CYP2E1

Question 14

Why are women more affected by alcohol?

Answer 14

because alcohol does not distribute in fat

Question 15

How long does it take for the body to clear one standard drink?

Answer 15

an hour

Question 16

Why can this rate not be increased?

Answer 16

Because alcohol dehydrogenase works at vmax after 2 drinks

Question 17

Why should patients on warfarin not drink alcohol?

Answer 17

because the CYP2E1 is up regulated so drugs will have less effect

Question 18

What causes alcohol induced liver damage?

Answer 18

neglecting dietary intake of antioxidants, alcohol interferes with transport of glutathione, increased use of CYP2E1, alcohol promotes absorption of iron - all of these cause increased free radicals, also acetaldehyde reacts with proteins and compromises their function

Question 19

What is Wernicke Korsakoff syndrome?

Answer 19

thiamin deficiency due to poor nutrition and alcohol metabolism

Question 20

What are the symptoms of Wernicke Korsakoff syndrome?

Answer 20

nystagmus, wide step, confusion, hypothermia, amnesia, confabulation

Question 21

What converts acetylaldehyde to acetate?

Answer 21

two forms of aldehyde dehydrogenase - ALDH2 is the mitochondrial form that is more important

Question 22

What causes Asian flush?

Answer 22

an inactive variant of ALDH2

Question 23

What is disulfiram?

Answer 23

A drug which inhibits ALDH used to treat alcoholics - causes tachycardia, nausea and vomiting when drinking

Question 24

What is a gene that contributes to alcohol addiction?

Answer 24

dopamine D2 receptor

Question 25

What are the signs of alcoholism on physical examination?

Answer 25

spider naevi, palmar erythema, gynaecomastia, feminisation of hair patterns, testicular atrophy, muscle wasting, enlarged liver, enlarged spleen, metabolic flap

Question 26

What liver enzymes would be elevated in alcoholic liver disease?

Answer 26

GGT, ALT and CDT

Question 27

How does alcohol cause dehydration?

Answer 27

by depressing the pituitary gland leading to decreased production of anti diuretics

Question 28

What is foetal alcohol syndrome?

Answer 28

irreversible birth disorders brought on by drinking alcohol during pregnancy