alcoholic disease

Question 1

list some complications of alcoholism by organ system

Answer 1

Liver: fatty liver / alcoholic hepatitis -> both may progress to CIRRHOSIS

CNS - decreased memory and cognition / cortical atrophy / confabulation / Korsakoff’s / Wernicke’s

gut - obesity / D&V / gastric erosions / peptic ulcers / varices / pancreatitis / ca

heart: arrythmias / dilated cardiomyopathy

reproduction - test atrophy / decreased testosterone / prog

Question 2

what might be seen on biopsy in alcoholic liver cirrhosis

Answer 2

mallory bodies

neutrophil infiltrates

Question 3

describe the mechanism of alcohol withdrawal

Answer 3

1. chronic alcohol consumption leads to enhancement of the GABA mediated inhibitory pathways in the CNS
   (a bit like benzos…)
2. also inhibits the NMDA glutamate receptors
3. acutely withdrawing from alcohol leads to the opposite effect (decreased inhibitory GABA and increased glutamate)

Question 4

what are the features of alcohol withdrawal?

Answer 4

Sx start at 6-12 hrs
- tremor / sweating / anxiety / tachycardia

Seizures peak at 36hours

DTs peak at 48-72hrs:
coarse tremor
confusion 
delusions
auditory / visual hallucinations
fever 
tachycardia

Question 5

how would you manage alcohol withdrawal / delirium tremens?

Answer 5

admit patients who have a history of dts / blackouuts when withdrawing to hopsital for monitoring until withdrawals stabilised

others can be managed at home

1. benzos - chlordiazepoxide (may use Loarazepam in pts with hepatic failure)
   reducing dose protocol with nice high doses to start
2. carbemazapine also effective

Question 6

give some features of wernickes

what is the pathophys….

and 2 investigations

and the key treatment

any other cccauses of wernicke’s?

Answer 6

features are NOAC-P

pathophys is deficiency of vitamin B1 (thiamine)

nystagmus
opthaalmoplegia
ataxia
confusion (+altered GCS)
peripheral sensory neuropathy

remember the triad by ‘WernOCA’s encephalopathy)
opthalmoplegia (ie nystagmus etc.)
confusion
ataxia

investigations:
decreased red cell transketolase (reduced in Vitamin b1 deficiientcy)

treatment:
GIVE PABRINEX IM ASAP
NB - if also hypoglycaemic - as is often the case - YOU MUST ALWAYS GIVE PABRINEX BEFORE GLCOSE - may precipitate wernickes

complications - KORSAKOFF’S SYNDROME

other causes:
malabsorption
anorexia

Question 7

What signs would suggest that wernickes is progressing to korsakoff’s (other than you not giving them thiamine quickly enough..)

Answer 7

+ AMNESIA (antero and retro grade)

+ confabulation