Alcoholism

Question 1

Pathophys of alcoholism?

Answer 1

FAtty liver - acute/reversible liver inflammation, progresses to cirrhosis
Cirrhosis
Alcoholic hepaittis

CNS - reduced memory/cognition, neuropathy, Korsakoff’s psychosis, Wernicke’s encephalopathy

Gut: Ibesity, G&V, PUD, varices, pancreatitis, oesophaeal rupture, Boerhaave’s syndrome

Blood:
Anaemia from alcoholism associated folate deficiency, GI bleeding

Heart -HTN

Repro - reduced testosterone

Question 2

What are signs of alcohol withdrawal?

Answer 2

starts 10-72h after last drink

Tachycardia
Hypotension
Tremor
Confusion
Fits
Hallucinations (delirium tremens)

Question 3

What are CF of alcoholism

Answer 3

CAGE questionnaire

Sx of liver disease

Question 4

What Ix in alcoholism?

Answer 4

LFT - AST:ALT>2, raised GGT
Albumin
Coagulation
FBC - macrocytic anaemia
Reduced platelets
Increased cholesterol
USS liver

Question 5

What is Mx for alcoholism?

Answer 5

Abstinence
Nutrition
Vitamin replacement
Liver transplant

Question 6

What is Mx for alcohol withdrawal

Answer 6

Admit only if complicating or coexisting medical problems

Chlordiazepoxide PO

Question 7

Advice for alcoholics?

Answer 7

GRaceful ways of declining a drink
Not buying themself a drink
Don’t lift glass to lips until slowest drinker takes sip
Sip dont gulp

Question 8

How to screen for unhealthy alcohol use?

Answer 8

CAGE questionnaire
Cut down alcohol consumption
Annoyed when people criticise drinking
Guilty 
Eye opener- drink first thing in the morning

Question 9

CF of alcoholic hepatitis?

Answer 9

Fever
Nausea
RUQ pain
Jaundice
Ascites
Oedema
Encephalopathy

Question 10

Ix in alcoholic hepatitis?

Answer 10

Raused WCC
Reduced platelets
Raised INR
Raised AST
Raised MCV
Raised Urea

Jaundince/encephalopathy/coagulopathy – severe

Question 11

Mx of Alcoholic hepatitis

Answer 11

Admit
Vitamins: K, thiamine - Pabrinex IV
Optimise nutrition
Daily weight, LFT, U&E, INR
Steroids - prednisolone