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Clasp 2 > Biochemistry of Alcohol > Flashcards

Biochemistry of Alcohol Flashcards

1
Q

name 6 things that alcohol can affect in the body

A 
liver
pancreas
heart
muscle
osmoregularity and coagulation
glucose metabolism
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2
Q

which effect of alcohol can cause a coma?

A

disturbance of glucose metabolism

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3
Q

how can you determine if there is any damage to heart and muscle?

A 
heart = measure troponin (specific to heart muscle)
muscle = measure creatinine kinase
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4
Q

how do troponin levels rise/fall over time?

A

cant be detected for around 6 hours after onset of pain

peak around 24-48 hrs after and then return to normal over 5-14 days

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5
Q

what tests are used to determine whether the patient is a chronic drinker?

A

GGT (increased)
Mean cell volume of red cells (increased)
triglycerides (increased)

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6
Q

what does a raised GGT with normal LFTs suggest and why?

A

chronic drinker

ethanol induces enzymes including P450 and GGT

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7
Q

what test is used to determine if a coma is due to alcohol or other factors?

A

serum osmolality

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8
Q

what other factors can cause a comatose state other than alcohol?

A

anti-convulsive medication (i.e epilepsy) as they also induce same emzymes

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9
Q

what is serum osmolality?

A

calculated concentration of electrolytes/dissolved solutes in aqueous phase of serum (Na, Ca, K, urea etc)

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10
Q

how is serum osmolality calculated generally?

A

2X [Na] as Na is always by far the most prevalent electrolyte
(usually around 275-295)

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11
Q

what is the osmolal gap?

A

difference between calculated serum osmolality and measured serum osmolality (shouldn’t be much)

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12
Q

patient comes into A&E in a comatose state, all electrolytes are normal but a large osmolal gap is present, what does this mean?

A

something else is in blood contributing to osmolality which is not measured (i.e ethanol or methanol etc)

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13
Q

why are methanol and ethylene glycol so dangerous?

A

metabolised to very acidic metabolites

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14
Q

what tests are used to determine if alcohol is the cause of abdominal pain?

A

amylase (checks pancreas)
LFTs (checks gall bladder etc)
ascetic fluid analysis

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15
Q

what is ALT (alanine aminotransferase) a marker of?

A

liver damage

released from hepatocytes when damaged

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16
Q

where is alkaline phosphatase (ALP) found in the body?

A 
bone
liver
small intestine
kidneys
placenta
17
Q

what is ALP a marker of?

A 
liver damage (found in bile canaliculi)
excessive bone formation (in osteoblasts)
18
Q

what does high GGT indicate?

A

liver damage/disease
pancreatitis
prostate/kidney disease

19
Q

what is albumin and how can it be used in testing?

A

plasma protein formed by the liver

can indicate problem in liver function if low

20
Q

why is albumin not a great marker of liver function?

A

it also falls during the inflammatory response as it is redistributed
half life of 3 weeks

21
Q

what is a good indicator of current liver function and why?

A

prothrombin time as clotting factors are synthesised in the liver and it has a shorter half life of 3-4 days

22
Q

what can cause prehepatic jaundice/unconjugated bilirubin overload?

A

haemolytic anaemia

23
Q

what can cause conjugated bilirubin overload?

A

obstruction (e.g bile duct etc)

24
Q

possible diagnosis of abdo pain in alcoholic?

A

acute pancreatitis
alcoholic hepatitis
peptic ulcer +/- perforation
ascites +/- fluid analysis

25
Q

what tests are done in a vomiting patient with suspected alcohol problems?

A

U&Es
LFTs
Amylase
ABG

26
Q

possible causes of vomiting in alcoholics?

A

acute gastritis
oesophageal stricture
pyloric stenosis

27
Q

how can you determine if a raised ALP is due to liver or bone?

A

check GGT

if raised GGT its liver

28
Q

what type of environments are the stomach and duodenum?

A

stomach = acidic
duodenum = alkaline
because the different enzymes work better in different environments

29
Q

whats the difference between normal vomiting and vomiting when you have pyloric stenosis?

A

normally the acid you lose when vomiting is compensated for by losing some alkali
this doesn’t happen in pyloric stenosis resulting in a metabolic alkalosis

30
Q

what tests are done for haematemesis suspected due to alcohol?

A

U&Es
LFTs
PTR
Lactate

31
Q

possible causes of haematemesis in alcoholic?

A

acute gastritis
Mallory Weiss tear
peptic ulcer +/- perforation
oesophageal varices

Clasp 2 (8 decks)

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