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RB Y2 CLASP - Alcohol > Alcoholism 3D > Flashcards

Alcoholism 3D Flashcards

1
Q

what is seen on the hands in chronic alcoholism

A

palmar erythema, nail changes and dupuytrens contracture

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2
Q

what is palmar erythema usually related to

A

underlying liver cirrhosis. inc oestrogen levels are thought to cause changes in the small anastomoses in the hand inc vascularity

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3
Q

what else can cause Dupuytren’s Contracure

A

anti epileptic drugs

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4
Q

what is Dupuytren’s Contracure

A

benign fibrosis of the palmar fascia

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5
Q

name 3 effects of alcoholism on the nerves and muscles

A

peripheral neuropathy, compression neuropathy and myopathy

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6
Q

peripheral neuropathy typical distribution

A

glove and sock - causes burning pain and weakness

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7
Q

compression neuropathy

A

caused by direct pressure on a nerve causing temporary damage to the myelin sheath

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8
Q

acute myopathy

A

occurs after a binge, myaliga, weakness, swollen tender muscles

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9
Q

chronic myopathy

A

painless proximal weakness and atrophy

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10
Q

compare the CK levels in acute and chronic myopathy

A

raised in acute, normal in chronic

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11
Q

what vitamin is thiamine

A

B1

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12
Q

what can occur in the brain

A

subdural haematoma - not uncommon to see multiple

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13
Q

subdural haematoma

A

alcohol use is associated with falling and subsequent neurological damage, this is a common consequence

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14
Q

name 3 consequences of deficiency of thiamine in the diet

A

wernicke’s encephalopathy, korsakoff’s syndrome and beri beri

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15
Q

name a relevant role of thiamine

A

maintain peripheral nerves

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16
Q

what is the classic triad of wernickes encephalopathy

A
  • confusion, ataxia and opthalmoplegia
  • need urgent thiamine replacement within hours, or can result in permanent signs and symptoms of Korwsakoff
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17
Q

what is opthalmoplegia

A

paralysis of muscles within or surrounding the eye

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18
Q

what tends to develop as wernickes goes away

A

korsakoffs syndrome

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19
Q

korsakoffs syndrome

A

results from permanent damage to areas of the brain involved in memory and associated with recent memory loss anterograde and retrograde amnesia

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20
Q

anterograde amnesia

A

inability to make new memories after the event that caused amnesia

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21
Q

retrograde amnesia

A

loss of memory access to events that occurred before the incident

22
Q

confabulation

A

patients making up new memories in the absence of the real ones

23
Q

wet beri beri

A

affects CV system

24
Q

dry beri beri

A

nervous system

25
Q

does alcohol have a positive or negative inotropic effect on the heart

A

negative - ‘heavy heart.’ tachycardia the morning after drinking as heat tries to maintain CO

26
Q

holiday heart syndrome

A
  • binge drinking in a person without any clinical evidence of heart disease that can result in acute cardiac rhythm/conductance disturbances
  • tends to be supraventricular tachyarrhythmia
27
Q

what type of cardiomyopathy does alcohol cause

A

dilated - most common cause

28
Q

what are the effects of alcohol on the stomach

A

natural irritant to the gastric mucosa, causes high conc of alcohol to be absorbed slower due to this irritation

29
Q

what is boerhaave syndrome

A

transmural oesophageal rupture due to persistent vomiting. Note Mallory-Weiss tear is a non-transmural rupture

30
Q

what component of alcohol metabolism is carcinogenic

A

acetaldehyde

31
Q

how does acetaldehyde cause cancer

A

as alcohol level inc, it is metabolised by alcohol dehydrogenase in areas other than the liver (stomach, upper Gi tract, upper airway). acetaldehyde builds up as there is a deficiency of aldehyde dehydrogenase.

32
Q

what unexpected type of cancer can alcohol cause

A

breast

33
Q

name a useful screening tool for alcohol dependence

A

AUDDIT

34
Q

delerium tremens

A

severe withdrawal symptom.- confusion, hyperactivity, can lead to CV collapse onset is 3 days in and lasts for 2 to 3 days

35
Q

how many calories does 1g of alcohol contain

A

7 calories

36
Q

what is used medically for assisted alcohol withdrawal

A

Chlordiazepoxide - benzodiazpeine class

37
Q

what is alcohols effect on HDL

A

increases it

38
Q

alcohol effect on the clotting factors

A

inhibits them - patients are more likely to bleed

39
Q

what type of receptors are GABA receptors

A

inhibitory

40
Q

what type of receptors are glutamate receptors

A

excitatory

41
Q

what does ethanol do to GABA and glutamate receptors

A

potentiate GABA and inhibit glutamate causing CNS depression

42
Q

what class of drugs are used in alcohol withdrawal and why

A
  • benzodiazepines - enhance the effect of GABA
  • eg Chlordiazepoxide
43
Q

alcohol misuse - F10.1

A

pattern of use that is causing damage to health - mental or physical

44
Q

F10.2

A

Dependence syndrome, 3 or more of:

  • Strong desire or compulsion to take alcohol
  • Difficulties in controlling use
  • Persistent use despite clear evidence of harm
  • Preoccupation with substance use
  • Increased tolerance
  • Physiological withdrawal state
45
Q

aspiration pneumonia

A
  • compounded by teh relaxant efects of alcohol on the upper airway musculature and effects on the CNS
  • most likely to occur on superior aspect of right lower lobe
  • Klebsiella often implicated
46
Q

mild alcohol withdrawal

A
  • Fine tremor, sweating, anxiety, hyperactivity, inc. HR, inc. BP, fever, anorexia, nausea, retching
47
Q

moderate alcohol withdrawal

A
  • Coarse tremor, sharking, agitation, confusion, disorientation, paranoia, seizures, hallucinations
  • up to 5 days
48
Q

severe alcohol withdrawal

A
  • Risk of DT (medical emergency) around 48 hours, severe agitation, anxiety, confusion, delusions, hallucinations
  • Circulatory collapse and death can occur
  • Up to 7+ days
49
Q

delirium tremens

A
  • Severe withdrawal
  • Rapid onset of confusion
  • Sympathetic overdrive, can lead to CV collapse, global confusion
  • Onset is usually 3 days into the withdrawal symptoms and lasts for 2 to 3 days
50
Q

define binge drinking

A
  • Binge drinking is defined as greater than 8 units in one day for women and men.

RB Y2 CLASP - Alcohol (3 decks)

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