Alcoholism Flashcards
CNS: Wernicke-Korsakoff
- thiamine multivitamin deficiency a
- confusion, confabulation, ataxia
CNS: polyneuropathy
- deficiency in B12 and folate
- peripheral neuropathy
Cardiac
-alcoholic cardiomyopathy: CHF, cardiomegaly, arrhythmias
Respiratory
-intrapulmonary shunts 2/2 portal HTN
GI
-esophagitis, gastritis, pancreatitis: ulceration/GI bleed
Hepatic: Fatty liver
- asymptomatic enlargement of the liver
- not surgery contraindication
- if heme/nutrition problem exist, delay for 6-8 weeks
Hepatic: Acute alcoholic hepatitis
- 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%
Hepatic: Cirrhosis
- ESLD
- surgery contraindicated
Glucose Homeostatis in liver failure
- 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
protein synthesis in liver failure: binding
- dec albumin levels
- drugs (barbiturates, diazepam, coumadin) will have inc free form in blood
protein in liver failure: distribuation
-pancuronium: increased volume of distribution 2/2 hypoalbuminemia–initial dose larger, but longer half life as well
Liver failure: coagulation
- 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
cholinesterase activity in liver failure
-prolonged effects of succs (v. rare)
drug conjugation in liver failure
- 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
Acute alcoholi intake
- dec MAC
- Dec cardiac and respiratory reserve
- dec gastric emptying and increases acid secretion
chronic alcohol intake
- increases mAC
- decreases cardiac and respiratory reserve
LABS: enzymatic function
- inc AST/ALT=hepatocellular dysfunction
- inc Alk phos/5-nucleotidase=cholestatic dysfunction
Labs: excretory function
- 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
Labs: synthetic function
- 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
LFTs
- Liver function tests: Albumin/PT
- Liver destruction tests: others
- dec in albumin most ominous
- elevated plasma globulin-usu autoimmune hepatitis
