Alcoholism

Question 1

CNS: Wernicke-Korsakoff

Answer 1

• thiamine multivitamin deficiency a
• confusion, confabulation, ataxia

Question 2

CNS: polyneuropathy

Answer 2

• deficiency in B12 and folate
• peripheral neuropathy

Question 3

Cardiac

Answer 3

-alcoholic cardiomyopathy: CHF, cardiomegaly, arrhythmias

Question 4

Respiratory

Answer 4

-intrapulmonary shunts 2/2 portal HTN

Question 5

GI

Answer 5

-esophagitis, gastritis, pancreatitis: ulceration/GI bleed

Question 6

Hepatic: Fatty liver

Answer 6

• asymptomatic enlargement of the liver
• not surgery contraindication
• if heme/nutrition problem exist, delay for 6-8 weeks

Question 7

Hepatic: Acute alcoholic hepatitis

Answer 7

• enlarged liver, elevated LFTs, alk phos
• fever, N/V, RUQ tenderness, anorexia, weight loss (elevated AST/ALT/Alk Phos –AST>ALT)
• mortality with surgery is 50%

Question 8

Hepatic: Cirrhosis

Answer 8

• ESLD
• surgery contraindicated

Question 9

Glucose Homeostatis in liver failure

Answer 9

• liver involved in gluconeogenesis and glycogenolysis
• glucose-containing solution should be infused to prevent hypoglycemia
• hypoglycemia occurs b/c 1)insufficient insulin degradation by the liver 2) impaired glucose formation 3) imparied glycogen depletion

Question 10

protein synthesis in liver failure: binding

Answer 10

• dec albumin levels
• drugs (barbiturates, diazepam, coumadin) will have inc free form in blood

Question 11

protein in liver failure: distribuation

Answer 11

-pancuronium: increased volume of distribution 2/2 hypoalbuminemia–initial dose larger, but longer half life as well

Question 12

Liver failure: coagulation

Answer 12

• all factors excet VIII produced in the liver
• coag function must be checked and corrected with FFP if necessary
• Vit K doesn’t correct prothrombin in hepatocellular damage, but does so in biliary obstruction
• platelet levels can be decreased because of hypersplenism

Question 13

cholinesterase activity in liver failure

Answer 13

-prolonged effects of succs (v. rare)

Question 14

drug conjugation in liver failure

Answer 14

• oxidation/conjugation make drugs more water soluble for excretion
• highly metabolized thru first pass: digitalis, diazepam, inderal, meperidine, pentazocine, verapamil, lidocaine
• dec liver blood flow (CHF), or dec metabolism by liver–these drugs accumulate

Question 15

Acute alcoholi intake

Answer 15

• dec MAC
• Dec cardiac and respiratory reserve
• dec gastric emptying and increases acid secretion

Question 16

chronic alcohol intake

Answer 16

• increases mAC
• decreases cardiac and respiratory reserve

Question 17

LABS: enzymatic function

Answer 17

• inc AST/ALT=hepatocellular dysfunction
• inc Alk phos/5-nucleotidase=cholestatic dysfunction

Question 18

Labs: excretory function

Answer 18

• bilirubin: elevated 2/2 inc production or dec excretion
• indirict bili:
  1) excess production–hemolysis/ineffective erythropoiesis
  2) impaired bili conjugation–gilbert’s, crigler-najjar
  3) reduced bili uptake by liver–heart failure
• direct bili elevation
• hepatocellular dysfunction or biliary tract obstruction

Question 19

Labs: synthetic function

Answer 19

• albumin, coag factors, cholesterol
• decreased albumin seen in chronic liver disease (half life is 21 days)
• all coag factors except VIII made in liver
• vit k dependent factors are II, VII, IX, X
• impaired synthetic ability detected by measurement of PT

Question 20

LFTs

Answer 20

• Liver function tests: Albumin/PT
• Liver destruction tests: others
• dec in albumin most ominous
• elevated plasma globulin-usu autoimmune hepatitis