Alcoholism

Question 1

What is alcohol?

Answer 1

Ethanol, short chain hydrocarbon with both polar (hydrophilic) and non polar (hydrophobic) molecules
Note: Because of its solubility ethanol has the ability to move across lipid bilayers and distributed in any areas where water is found in the body

Question 2

Describe alcohol metabolism?

Answer 2

• blood alcohol levels are higher if alcohol is consumed with an empty stomach
• alcohol dehydrogenase (ADH), first-pass metabolism (FPM) in gastric mucosa

Question 3

What are the 3 pathways in hepatic metabolism?

Answer 3

1. alcohol dehydrogenase (ADH)
2. cytochrome p450
3. catalase

Question 4

Alcohol dehydrogenase pathway?

Question 5

Cytochrome p450 pathway?

Question 6

Catalase pathway?

Question 7

Pathogenesis of hepatic metabolism?

Answer 7

1. hypoxia
2. adduct formation
3. ROS and reduced antioxidants

Question 8

Pathogenesis of hypoxia?

Answer 8

The metabolism pathways require the hepatocytes to take up enough oxygen to bind to Hydrogen to form H2O

Question 9

Significant alcohol related hypoxic damage to hepatocytes is in which zone?

Answer 9

zone 3

Question 10

Pathogenesis of adduct formation?

Answer 10

Acetaldehyde and ROS interacts with protein building blocks

-Acetaldehyde Adducts: Red Cell Membrane, Lipoproteins,Tubulin,Hemoglobin,Albumin,Collagen→ induce an immune system→ immune mediated hepatotoxicity etc.

-Through the CYP2E1→ ROS→Lipid peroxidation→ Malondialdehyde (MDA)→formation of adducts with proteins

Question 11

Pathogenesis of ROS and reduced antioxidants?

Answer 11

inflammation
carcinogenesis
atherosclerosis
aging

Question 12

CAGE questions and how they can diagnose alcohol abuse?

Answer 12

1. Ever thought of Cutting down on your drinking
2. Annoyed when criticized
3. Guilty about your drinking
4. Eye opener in the morning
   NB: yes to ≥2 good at detecting alcohol abuse

Question 13

Effects of alcohol on the GIT?

Answer 13

1. Interferes with digestion in the small intestines→ diarrhoea
2. Closure of pylori sphincter→ vomiting
3. Nausea
4. Dry mouth
5. Peptic ulcers
6. Pancreatitis
7. Oral mucosal ulcers
8. Carcinoma

Question 14

What is alcoholic fatty liver?

Answer 14

AFL is a liver injury that is completely reversible upon abstinence from alcohol
- Diagnosis of AFL requires a fat deposition >5% of the liver cells

Question 15

Alcoholic steatohepatitis vs alcoholic hepatitis?

Answer 15

1. Unlike ASH, AH commonly presents as a severe disease with a high risk of complications.
2. AH is characterized by poor nutritional condition, enlarged liver and spleen, jaundice, ascites, mental alterations, and hepatic as well as renal insufficiency.
3. The liver histology of ASH is described as hepatic injury with steatosis.

Question 16

Features of alcoholic hepatitis?

Answer 16

1. Anorexia
2. vomiting
3. tender hepatomegally
4. ±jaundice /bleeding

Question 17

Lab features of alcoholic hepatitis?

Answer 17

↑ ALT
↑↑ AST
↑GGT
↑MCV

Question 18

Describe alcoholic liver cirrhosis?

Answer 18

AC pts often have no symptoms

Question 19

Complications of alcoholic liver cirrhosis?

Answer 19

1. ascites
2. bleeding from ruptured oesophageal varices
3. hepatic encephalopathy

Question 20

Effects of alcohol on the blood?

Answer 20

1. ↑MCV
2. Anaemia → folate def, GI bleeding, bone marrow depression, haemolysis

Question 21

Effects of alcohol on the heart?

Answer 21

1. Arrhythmias(Holiday Heart Syndrome)
2. ↑BP
3. Cardiomyopathy(e.g. Wet Beriberi)
4. Sudden death from binge drinking

Question 22

Alcohol effects on the CNS and PNS?

Answer 22

1. Acute → headaches, dizziness, blackouts (anterograde amnesia) confusion, coma, ataxia, convulsion
2. Pyschological → depression, anxiety, pyschosis, hallucinations, delusions, sleep disorders.
3. Retro bulbar neuropathy
4. Peripheral neuropathy

Question 23

Korsakoffs syndrome?

Answer 23

Reduced ability to acquire new memories

Question 24

Wernickes syndrome?

Answer 24

Due to thiamine deficiency(may also be seen in pregnancy, malignancy) other than alcoholics
NB: if there is on going memory loss= Wernicke’s-Korsakoff’s syndrome

Question 25

Features of Wernickes syndrome?

Answer 25

1. opthalmoplegia
2. ataxia & confusion ± memory loss
3. hypotension
4. hypothermia
5. ↓ LOC

Question 26

Treatment of Wernickes syndrome?

Answer 26

give IV thiamine

Question 27

What is alcohol withdrawal syndrome?

Answer 27

Situation where ethanol withdraw presents with confusion and other clinical features.

Question 28

What causes alcohol withdrawal syndrome?

Answer 28

1. sympathetic outflow over drive.
   alcoho l= ↑ inhibition of excitatory neurotransmitters i.e glutamate & ↑ effects of inhibitory neurotransmitters i.e endogenous opiates, GABA receptors
2. abrupt cessation = loss of inhibition & ↑excitation

Question 29

Clinical presentation of alcohol withdrawal syndrome?

Answer 29

1. Minor: 6-24 hrs, vomiting, tremors & insomnia
2. Major (alcoholic hallucinations): 10-72 hrs, visual and auditory hallucinations, tremors, sweating, vomiting.
3. Withdrawal seizuires: 6-48 hrs
4. Delirium Tremens: 3-10 days, severe agitation, profound confusion, fever, tachycardia, hypertension, hallucinations, sweating.

Question 30

Treatment of alcohol withdrawal syndrome?

Answer 30

1. Benzodiazepines
2. correct hypoglycaemia
3. Give IV thiamine 100mg QID for 3 days
4. folate
5. Anti-seizure meds for convulsions.
6. Anti-psychotics for hallucinations.