Alcoholism Flashcards by Hannah Felicity Starling

Broadly, what health effects can alcohol have and which diseases does it put you at risk of?

Disrupts sleep
Makes you pee more
Harms the stomach
Increases blood sugars
Increase blood pressure
Triggers migraines

Pancreatitis
Diabetes 
Hypertension
Liver disease
CVD
Breast, bowel, oral, liver cancer

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What are the symptoms of alcohol poisoning?

Confusion
Loss of coordination
Vomiting
Seizures
Bradypnoea
Pallor
Hypothermia
Stupor 
Unconsciousness

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What is stupor?

Conscious but unresponsive

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What should you do if you think someone has alcohol poisoning?

Keep them sitting and awake
Give them water
Recovery position
Keep them warm
Stay with them

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What is delirium tremens?

Acute confusional state resulting from someone who excessively drinks, stopping suddenly

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What can delirium tremens lead to?

Seizures and death

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How do we treat delirium tremens?

Oral lorazepam

Second line:
Parenteral lorazepam or haloperidol

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How do we assist with alcohol withdrawal?

Treat them in a community setting under an alcohol service. e.g alcoholic anonymous

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Which drugs can be given for acute alcohol withdrawal?

Diazepam or Chlordiazepoxide
Carbamezepine
Clomethiazole
Pabrinex
Thiamine if necessary

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What do we use to treat alcohol misuse that isn’t acute and what are they for?

Acamprosate - prevents a relapse
Disulfiram - causes unpleasant physical reactions if you drink alcohol
Naltrexone - blocks opioid receptors that react to alcohol
Nalmefene - blocks opioid receptors that crave alcohol

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What is Wernicke’s encephalopathy?

Thiamine deficiency (B1 vit) causing neurological lesions
Medical emergency

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How do we treat Wernicke’s encephalopathy?

Pabrinex

Parenteral thiamine

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When do we give thiamine?

Those who are malnourished
Decompensated liver disease
Wernicke's encephalopathy
Those in acute alcohol withdrawal
Those titrating off alcohol

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What is pabrinex?

It is a mix of B and C vitamins: thiamine, riboflavin, pyridoxine, nicotinamide and ascorbic acid

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Why should you talk to relatives of someone you think it alcoholic?

Most alcoholics are in denial

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Which organs are affected by alcohol?

Liver
CNS
Gut
Blood
Heart
Reproduction
TRAUMA

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What is gamma GT?

Gamma glutamyltransferase

It is important in turning amino acids into peptides.

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What is raised gamma GT caused by?

It is a marker of liver, biliary and pancreatic diseases.

High on its own would indicated alcohol abuse or alcoholic liver disease

If raised with all other LFTs, not specifically helpful, just suggests liver inflammation

It is helpful if ALP is raised because ALP is raised either due to liver or bone. If GGT is also raised then the ALP raise would be due to the liver problems.

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Which liver problems can alcohol cause?

Can make fatty liver progress to cirrhosis
Alcoholic hepatitis
Cirrhosis

Which diseases/lifestyle factors can cause fatty liver?

Obesity
DM
Alcohol
Amiodarone

How many with alcoholic hepatitis progress to cirrhosis?

80% with 10% having failure

What is the biopsy result of alcoholic cirrhosis and NAFLD?

mallory bodies, sometimes with neutrophil infiltrate

What is the prognosis of Alcoholic cirrhosis?

48% 5 yr survival which increases to 77% if drinking stops

What CNS problems can be caused by alcohol?

Reduced cognition
Cortical atrophy
Retrobulbar neuropathy (eye problems)
Fits
Wide gait
Neuropathy
Korsakoff's
Wernicke's encephalopathy

What is Korsakoff's syndrome?

Hypothalamic damage and cerebral atrophy due to thiamine deficiency - can progress to Wernicke's S/S - confabulation (invent memories), lack of insight, reduced ability to make new memories Rx as Wernicke's

What are the symptoms of Wernicke's encephalopathy?

Classic triad of confusion, ataxia and ophthalmoplegia..

What problems with the gut can alcohol cause?

``` Obesity D/V Ulcers Varices Pancreatitis Cancer Oesophageal rupture ```

How does one rupture one's oesophagus?

Tries to vomit against a closed glottis

What blood disorders result from alcohol?

``` Macrocytic anaemia from: marrow depression GI bleed Folate/B12 deficiency Haemolysis ``` Sideroblastic anaemia

Which heart problems arise from alcoholism?

Arrhythmia (low K+) HTN Cardiomyopathy Sudden death

What does alcohol do to reproduction?

Testicular atrophy Reduced testosterone and increased oestrogen Foetal alcohol syndrome

What is foetal alcohol syndrome?

low IQ Short palpebral fissure (eye width) Absent philtrum (upper lip indent) Small eyes

What are the signs of alcohol withdrawal/

``` Hallucination - visual or sensation (crawling sensation) Tachycardia HBP Tremor Convulsion Fits Delirium tremens ```

When does alcohol withdrawal start?

10-72 hours after last drink

What can you suggest people try when wanting to cut down on alcohol?

Little things such as 1) instead of saying no "I'm seeing what it is like to go without for a bit" 2) follow the pace of the slowest drinker 3) Sip, don't gulp 4) buy a non-alcoholic drink when it's your round

How many alcoholics relapse?

About 50%

How do we screen for alcoholism?

CAGE questionnaire AUDIT with C How many times in the past year have you had 5 or more drinks in a normal day?

What is the CAGE questionnaire?

Have you ever felt you should Cut down on drinking? Do you get Annoyed if someone tells you to stop? Have you ever felt Guilty about your drinking? Do you ever need a drink to get you going in the moning? Eye-opener Yes to two or more indicates dependency

If you take bloods from a suspected alcohol abuser, what would you expect to see?

``` Raised: GGT ALT MCV AST:ALT ``` Reduced: urea platelets

What are the signs of alcoholic hepatitis?

``` Malaise Raised obs Anorexia D/V Hepatomegaly Jaundice Ascites ```

What are the blood results of alcoholic hepatitis?

Raised WCC Decreased platelets (hypersplenism/toxicity) Raised INR Increased AST, MCV, urea and INR

What is the triad of severe alcoholic hepatitis?

Jaundice, encephalopathy, coagulopathy

What is the management of alcoholic hepatitis?

Monitor urine and maybe CVP Screen for infection Stop alcohol, give chlorodiazepoxide/lorazepam for withdrawal Give Vit K 10mg/day and thiamine/pabrinex Optimise nutrition Give protein to prevent encephalopathy, sepsis and death Daily weight, LFT, UE and INR Steroids if severe

What is the Maddrey Discriminant Factor and what does it tell us?

Based on PTT and bilirubin Tell us mortality. If score over 31 and encephalopathic, then give prednisolone if not septic or variceal bleeding

What is the prognosis of alcoholic hepatitis?

50% dead at 30 days if severe | 40% dead one year after admission, a sobering thought (har har)