Case 3 - alcohol

Question 1

how is alcohol absorbed

Answer 1

absorbed form the upper small intestine via the portal vein and is then transported to the liver

Question 2

what is some alcohol in the stomach metabolised by

Answer 2

alcohol dehydrogenase

Question 3

why is womens safe limit less than men

Answer 3

they have a lack of alcohol dehydrogenase

Question 4

where is the rest of alcohol metabolised

Answer 4

the liver

Question 5

what happens in the liver to this alcohol

Answer 5

converted to acetaldehyde and excreted by conversion to carbon dioxide in citric acid cycle

Question 6

what enzyme is involved in the metabolism of alcohol in the liver

Answer 6

cytochrome p4502E1

Question 7

what is alcohol at low levels

Answer 7

a stimulant

Question 8

what happens if there is chronic use of alcohol

Answer 8

it has depressant effects on the CNS , mainly depression of cardiovascular and repsiratory centres in the brainstem

Question 9

at low doses, what does alcohol protect against

Answer 9

atheromas

Question 10

what is Wernicke’s encephalopathy

Answer 10

decreased thiamine effects mammiliary bodies in the brain

Question 11

what is induced in alcohol related disease mechanisms

Answer 11

induction of enzyme systems, especially cytochrome p450

Question 12

what is the biggest nutrient deficiency

Answer 12

vitamin B

Question 13

what is the early change in alcohol liver disease

Answer 13

acute fatty change

Question 14

which area does this acute fatty change usually affect

Answer 14

predominantly acinar zone 3 - this area is furthest away from a blood supply

Question 15

features of acute fatty change

Answer 15

Mainly large droplet
May cause acute hepatic failure
Reversible on withdrawal of alcohol

Question 16

what is alcoholic hepatitis

Answer 16

alcoholic steatohepatitis

Question 17

what is alcoholic steatohepatitis

Answer 17

fatty change, mainly large droplet

Question 18

what is there an accumulation of in alcoholic hepatitifs

Answer 18

Intracytoplasmic accumulation of cytoskeletal components (keratin)

Question 19

what is associated with alcoholic steatohepatitis

Answer 19

associated neutrophil polymorph infiltration

Question 20

what is non-alcoholic steatophepatitis

Answer 20

Identical features to alcoholic hepatitis
Associated with obesity, diabetes mellitus, hyperlipidemia, drug use (corticosteroids)
May progress to fibrosis and cirrhosis
Reversible on correction of underlying factor

Question 21

what is hepatic fibrosis, where does it start and what is it caused by

Answer 21

Starts in acinar zone 3
Initially pericellular fibrosis
Caused by activation of hepatic stellate (ito) cell = facultative myofibroblast
Reversible by TIMPs on withdrawal of alcohol

Question 22

is cirrhosis reversible

Answer 22

no

Question 23

what happens when there is liver failure as a result of cirrhosis

Answer 23

Protein synthesis: low albumin
Coagulation factors: bleeding
Hyperoestrogenism: gynacomastia, gonadal atrophy, Dupuytren’s contracture, liver palms, spider naevi
Jaundice
Encephalopathy: confusion

Question 24

what are the blood tests that can be done to identify heavy drinkers

Answer 24

gamma glutamyl transferase (GGT)
Mean corpuscular volume (MCV)

Screening tools:
CAGE or AUDIT can help

Question 25

what score on the CAGE test is clinically significant

Answer 25

2 or greater

Question 26

what is an addict

Answer 26

someone who has no control over their behaviour, lacks moral fibre, uses a maladaptive coping mechanism and has an addictive behaviour

Question 27

what is addiction

Answer 27

: a need for a drug, the use of a substance that is psychologically and physiological addictive, showing tolerance and withdrawal

Question 28

what is dependency

Answer 28

showing psychological and physiological withdrawal

Question 29

what are the three theories of addiction

Answer 29

Moral model; addiction as a result of weakness and a lack of moral fibre

Biomedical model; addiction as a disease

Social learning theories; behaviours that are learned according to the rules of the learning theory

Question 30

what is the moral model of addiction

Answer 30

addicts are weak, and can overcome a compulsion to use with willpower
Drug abusers choose to use drugs
Drug abusers are anti-social and should be punished
Drugs are evil

Question 31

what is the biomedical model of addiction

Answer 31

addiction is a brain disease
Neurotransmitter imbalance
Disease model:
Agent: drug
Vector: dealers
Host: addict
need to stamp out the disease by eliminating drugs
Drug antagonist medicine e.g Wellbutrin, naltrexone, Antabuse

Question 32

what is the social model of addiction

Answer 32

drug use is a learned behaviour
Classical conditioning: associative behaviour
Operant conditioning: probability of behaviour occurring Is increased if it is either positively reinforced by the presence of a positive event, or negatively reinforced by the absence or removal of a negative agent
Observational learning/modelling: behaviours are learnt by observing significant others carrying them out
Cognitive factors: factors such as self image, problem solving behaviour, coping mechanisms

Question 33

what does alcohol do to GABA interneurones

Answer 33

alcohol inhibits the inhibition of GABA interneurones have on dopamine neurones

Question 34

what happens when dopamine interneurones are dis inhibited

Answer 34

increase in dopamine

Question 35

what happens when there is extra dopamine in the brain

Answer 35

the dopamine receptors up regulate

Question 36

what happens then, when you are presented with the stimulus of alcohol

Answer 36

your response is dampened, therefore you have to drink more to maintain the state of reward sensation and so you become addicted