CLASP Alcohol Flashcards by Joe McAuley

Where may methanol be found sometimes

Home brew alcohol - it is toxic

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What is methanol metabolised into

Formaldehyde (fixes tissue)

Then Formic acid (dissolves you)

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Main symptom of methanol poisoning

Blindness

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How is methanol poisoning treated

Ethanol +/- dialysis

Ethanol - competitive inhibitor

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What enzyme metabolises both ethanol and methanol

Alcohol dehydrogenase

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Why does drinking on a full stomach reduce alcohol absorption rate

Reduced gastric emptying - more metabolised in stomach instead of being absorbed into blood stream

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Where is alcohol absorbed

Mainly small intestine, some in stomach

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Which drugs increase gastric emptying therefore increase the rate of alcohol absorption into bloodstream

Antihistamines
Domperidone
Metoclopramide

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Effect on absorption of drinking high conc alcohol

Reduced absorption - irritates gastric mucosa, delays emptying

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Why do men have higher alcohol tolerance than women

Men are leaner - greater dilution volume

Women also have reduced alcohol dehydrogenase activity

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Where is alcohol metabolised

Liver (mainly)
Pancreas
Brain

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Where is alcohol excreted

Urine
Breath
Sweat
Stool

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Rate of alcohol removal from body

15mg/100ml/hour = 1 unit/hour

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When does alcohol concentration peak

1 hour after absorption

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How does blood alcohol concentration decrease

Linearly

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Which ethnic groups have reduced alcohol dehydrogenase

Aboriginis, eskimos

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Why do some people flush and feel sick after alcohol

Low ALDEHYDE dehydrogenase enzyme - acetaldehyde builds up

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Which drug can be used to manage chronic alcoholism

Aldehyde dehydrogenase inhibitor - disulfaram/anabutase - causes them to flush and be sick

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Why do people who drink more have higher tolerance

Alcohol dehydrogenase upregulated

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Which alternative pathway of alcohol metabolism is activated in chronic drinkers?

MEOS pathway - cytochrome P450 family of proteins

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Which 3 biochemical processes are impaired in chronic alcoholism

Gluconeogenesis
Kerbs cycle
Fatty acid oxidation

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Why may you be sore after a night of drinking

Krebs cycle inhibited - anaerobic metabolism - lactic acid builds up

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What 2 processes start in the liver when blood glucose is low after a night of heavy drinking

Gluconeogenesis (using fat, proteins etc)

Glyocogenolysis

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Why does alcohol make you gain weight

Impaired fatty acid oxidation
Excess lipid synthesis
plus calories in alcohol

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How can DKA and alcoholic ketoacidosis be differentiated

DKA - massive hyperglycaemia | Alcoholic KA - little/no hyperglycaemia

The level of which neurotransmitter is increased by alcohol

GABA

How can you die from acute intoxication

Aspiration - unconscious, swallowing impaired, vomit and aspirate Trauma - misadventures, falls, fights Vomiting - metabolic alkalosis, mallory-weirs, boerhaave syndrome, acute pancreatitis

Release of what hormone is inhibited in alcohol

ADH

Why does alcohol give you a heavy heartbeat

-ve inotrope | therefore heart rate increases

What is holiday heart syndrome

Binge drinking causing spontaneous SVT

What contributes to a headache the day following

Congeners - substances used to make alcohol smell a certain way Serotonin Dehydration Acetic acid

Why can alcohol cause heartburn the next morning

Smooth muscle relaxant - GORD | therefore also causes snoring/suppression of cough/gag

Brain injury caused by falling when drunk

Subdural haematoma

2 things that thiamine (B1) deficiency causes

Beri-beri | Wernicke-Korsikoff syndrome

Symptoms of wernicke korsakoff syndrome

Ataxia Abnormal eye movements Impaired consciousness/memory loss

Confabulation

Seen in Wernicke Korsakoff syndrome (or just korsakoff) - can't make new memories so make up lies to disguise this

Why can you get neuropathy in alcoholism

Thiamine maintains peripheral nerves: - Foot drop - Wrist drop - Pain More rarely - arrhythmias/CCF from CNX involvement

Consequence of aspiration into lungs

``` Acute inflammation (pneumonitis) Later infection (pneumonia) ```

What heart disease is assoc with chronic alcoholism, and what dies this pose a risk of

Dilated cardiomyopathy (big, heavy heart with normal wall thickness) Arrhythmias, CCF

Name of thiamine deficiency along with cardiac arrhythmias and CCF in alcoholics

Wet Beri Beri

Initial liver disease after 1-2 days of heavy drinking

Alcoholic fatty liver (aka steatosis)

Reason for increased intracellular fat seen in AFLD

- More fatty acids delivered to liver - Alcohol converts NAD>NADH, stimulating lipid synthesis - Fatty acid oxidation is reduced - Reduced fat export by tubulins

Liver disease seen after 3-4 weeks of heavy drinking

Alcoholic steatohepatitis (fat accumulation + inflammation) | direct toxicity of alcohol causes inflammation

Symptoms of steatohepatitis

Fever Jaundice Tender liver

What are all of these things seen in alcoholic steatohepatitis: - Acute inflammatory cells - Ballooning - Mallory bodies

- lymphocytes - Fat inclusions in hepatocytes - Damaged intermediate filaments (stain dark purple)

Which cells deposit scar tissue around hepatocytes in cirrhotic liver

Interstitial cells of Ito

Where specifically is collagen deposited by cells of Ito and what does this leave behind

Space of Disse Islands of functioning hepatocytes surrounded by bands of scar tissue

Why do 'islands of hepatocytes' function poorly in cirrhosis

Reduced blood supply and capacity to metabolise it, so toxic waste build up

Where is blood directed through if poor cirrhotic flow

Splenic vein Oesophageal veins Anorectal veins Superficial veins

How can hypoglycaemia be caused by alcohol

Reduced gluconeogenesis - dangerous in diabetics

Type of cancer caused by barret's

Adenocarcinoma

What is a varied

Abnormally dilated vein

In pancreatitis the lipase enzyme is prematurely activated and digests pancreatic cells, what is this process called?

Fat necrosis

Normal intestinal epithelium?

Columnar epithelium with goblet cells

In pancreatitis, enzymes come into contact with fat and turn it into soap, what is this process called?

Saponification

Difference between Wernicke and Korsakoff syndrome

Wernicke - Walking - ataxia, abnormal eye movements (reversible) Korsakoff - memory loss, confabulation (irreversible)

In alcoholism, MCV is increased/decreased

Increased

Why do triglyceride levels increase in excessive liver

Increased lipid synthesis in liver

Tests to see if a patient is a chronic drinker

``` Gamma GT (raised) MCV (raised) Triglycerides (raised) ```

What tests are done when a patient comes into hospital in a coma

``` Blood glucose (hypoglycaemia) Serum osmolality ```

Calculation for serum osmolality?

Roughly = 2 x Na conc

How is serum osmolality used to determine if a patient is in an alcoholic coma

Osmolal gap = serum osmolality - calculated osmolality Big gap = ethanol contributing

tests if main complaint of patient is vomiting

U&E LFT Amylase ABG

U&E of an alcoholic who is vomiting

Low potassium Low sodium High urea and creatinine (reduced GFR)

tests for a patient who presents with haematemesis

U&E LFT PTR Lactate

Why is urea classically raised in haematemesis

You're absorbing your own blood, which contains proteins

What poison is seen in antifreeze? Treatment

Polyethylene glycol (antifreeze) Ethanol again

What is the meyer-overton rule

As the number of carbons in an alcohol increases, so too does its ability to act as a general anaesthetic

Cut off point for general anaesthetic effect of alcohol

hexanol-pentanol, then decreases

What neurotransmitters does alcohol effect

Glutamate (excitatory) GABA, Glycine (inhibitory)

Ethanols effect on neurotransmitters causes what?

CNS depression

Drink drive limit

0.05mg/100ml

Definition of harmful alcohol use

Misuse for 1 month

Criteria of alcohol dependence syndrome

``` Strong compulsion to take alcohol Difficulties in controlling alcohol use Using alcohol despite evidence of harm Preoccupation with alcohol use Increased alcohol tolerance Physiological withdrawal ```

Screening tests to determine patient's dependence on alcohol

FAST - before treatment AUDIT Screen - after treatment

What drugs help alcohol withdrawal

Chlordiazepoxide/Diazepam Oxazepam

What is Child Pugh score

Calculate prognosis in cirrhosis and assess suitability for drugs e.g. chlordiazepoxide

Supportive treatment given to alcoholics

Oral thiamine IM/IV Pabrinex (multi vitamins)

What is thiamine used for in body

co-enzyme for krebs cycle

Next step if alcohol withdrawal patient is delirious

Admit to hospital | IV pabrinex

What happens 2-3 days into alcohol withdrawal

Delirium tremens

What causes wernicke encephalopathy

Lactic acid in brain

What causes korsakoff syndrome

Irreversible brain damage from lactic acid in brain

Apart from Disulfarim, what can be given in chronic alcoholism

Acamprosate - reduces cravings

What type of stroke commonly presents in drinkers

Haemorrhagic

What neuro disease is common in drinkers

Amnesia

Chronically, what arrhythmia might alcoholism lead to

Long QT syndrome