Clinical effects of chronic alcoholism

Question 1

What can be seen on the palms of an alcoholic?

Answer 1

Palmar erythema

Duputren’s contracture

Question 2

Why do chronic alcoholics have palmar erythema?

Answer 2

Underlying liver cirrhosis

Increased oestrogen levels cause changes in small anastomoses in the hand, increasing vascularity

Question 3

What might be seen on the stomach of a chronic alcoholic?

Answer 3

Caput medusae

Question 4

What are caput medusae?

Answer 4

Prominent veins around the umbilicus

Question 5

What causes caput medusae?

Answer 5

Portal hypertension

Question 6

What are spider naevi?

Answer 6

Superficial veins across the chest

Question 7

What is a subdural haematoma?

Answer 7

Bleeding in the subdural space

Question 8

What causes subdural haematomas in alcoholic?

Answer 8

Falling over

Question 9

What deficiency is seen in chronic alcoholics?

Answer 9

Thiamine deficiency

Question 10

What is confabulation?

Answer 10

When a patient tries to mask memory loss in conversation

Question 11

What can thiamine deficiency manifest as?

Answer 11

Wernicke-Korsakoff’s syndrome

Question 12

What signs are found in Wernicke-Korsakoff’s syndrome?

Answer 12

Abnormal shaky gait (ataxia)
Nystagmus
Ophthalmoplegia
General confusion
Disorientation
Memory loss

Question 13

What type of pneumonia is common in alcoholics?

Answer 13

Aspiration pneumonia

Question 14

Why might scarring be visible on the lungs of a chronic alcoholic?

Answer 14

Previous bouts of aspiration pneumonia

Question 15

How does alcohol affect cardiac contraction?

Answer 15

Directly negative inotropic affect

Therefore HR increases

Question 16

What effect does chronic alcoholism have on the heart?

Answer 16

Dilated cardiomyopathy

Question 17

Why does wet beriberi cause heart failure?

Answer 17

Causes peripheral vasodilation and rapid arterio-venous shunting of blood

Question 18

What is NAD converted to by alcohol and what does this go on to stimulate (in the liver)?

Answer 18

NADH

Stimulates lipid synthesis

Fatty liver

Question 19

What causes acute fatty liver?

Answer 19

NAD -> NADH by alcohol
Stimulates lipid synthesis
Alcohol reduces mitochondrial oxidation of fatty acids
Decreased transport of fat out of hepatocytes due to intracellular tubulin impairment

Question 20

How does alcoholic steatohepatitis present?

Answer 20

Fever
Liver tenderness
Jaundice

Question 21

What is seen on a microscopic level in alcoholic steatohepatitis?

Answer 21

Acute inflammatory cells
Hepatocyte ballooning
Profound cellular steatosis
Presence of Mallory’s hyaline

Question 22

What type of symptoms will a patient with liver cirrhosis develop?

Answer 22

Symptoms of portal hypertension

Question 23

What causes cirrhosis?

Answer 23

Fibrosis deposited in interstitial cells.
Eventually this scarring encircles hepatic lobules.
Entrapped hepatocytes have a reduced capacity to receive substances and secrete substances
Causes net build up of toxic material

Question 24

What large veins are seen in portal hypertension?

Answer 24

Oesophageal varices

Splenomegaly

Question 25

What causes gastritis during alcohol consumption?

Answer 25

Acute inflammatory cells (neutrophils)

Question 26

Repeated vomiting can cause mucosal tears. This can cause what?

Answer 26

Mallory-Weiss tear | Boerhaave syndrome

Question 27

What is Boerhaave syndrome?

Answer 27

Oesophageal rupture

Question 28

What pathological change is seen in Barrett's oesophagus?

Answer 28

Normal oesophageal squamous epithelium changes to columnar lined mucosa

Question 29

What is a varix?

Answer 29

An abnormal dilatation of a vessel

Question 30

What are some theories about acute pancreatitis?

Answer 30

Alcohol could be toxic to pancreatic acinar cells/ductal epithelial cells Premature activation of digestive enzymes (results in autodigestion of pancreas)

Question 31

What is the digestion of fat called?

Answer 31

Saponification

Question 32

What is the pathology of chronic pancreatitis?

Answer 32

Secretion of proteinaous material into pancreatic ducts - eventually obstructing them Scarring, sclerosis, pseudocyst formation with fat necrosis

Question 33

What is a pseudocyst?

Answer 33

Cysts are usually have an epithelial lining A pseudocyst does not

Question 34

Why do pseudocysts occur in chronic pancreatitis?

Answer 34

result of tissue necrosis and degeneration

Question 35

Thiamine is phosphorylated in the gut to an active coenzyme form which is important for what?

Answer 35

ATP production Normal nerve conduction Maintenance of neural membranes

Question 36

Levels of thiamine are rapidly reduced in chronic alcohol abuse. What does this lead to?

Answer 36

``` Poor intake Decreased conversion to conenzyme Reduced storage in fatty liver Inhibited intestinal absorption Increased metabolic demand ```

Question 37

What water soluble vitamins can chronic alcoholics be deficient in?

Answer 37

B and C | Folate and B 12 resulting in megaloblastic anaemia

Question 38

What is pellagra?

Answer 38

Vitamin B3 deficiency

Question 39

What signs/symptoms does a patient with pellagra have?

Answer 39

Dementia/Depressive psychosis Photosensitive Dermatitis Diarrhoea Death

Question 40

What fat soluble vitamins can chronic alcoholics be deficient in?

Answer 40

A D E K

Question 41

What is vitamin A responsible for?

Answer 41

Storage and synthesis of retinol binding protein

Question 42

What does vitamin A deficiency cause?

Answer 42

Reduced levels of plasma retinol Leads to night blindness

Question 43

What minerals can chronic alcoholics be deficient in?

Answer 43

Calcium Zinc Selenium

Question 44

How is Ca secretion increased in chronic alcoholism?

Answer 44

Increased urinary secretion

Question 45

What are the alcohol limits for men and women?

Answer 45

14 units per week spread over 3 days

Question 46

What are the 6 cancers that are strongly associated with alcohol?

Answer 46

``` Breast Bowel Liver Mouth/throat Oesophageal Stomach ```

Question 47

When do seizures tend to occur after alcohol ingestion by susceptible individuals (e.g. epilepsy)?

Answer 47

Morning after acute intoxication

Question 48

What is peripheral neuropathy caused by?

Answer 48

Thiamine deficiency

Question 49

What is compression neuropathy?

Answer 49

Temporary damage to myelin sheath 'Saturday night palsy'

Question 50

What is the pathology of Wernicke-Korsakoff syndrome?

Answer 50

Thiamine deficiency and cytotoxic oedema in mamillary bodies

Question 51

What are the characteristic features of Korsakoff syndrome?

Answer 51

Profound anterograde amnesia Variable retrograde amnesia Confabulation

Question 52

What is confabulation?

Answer 52

Replaces memory with information able to retain at that time and believes it to be true

Question 53

What is profound anterograde amnesia?

Answer 53

Unable to retian new info

Question 54

What is variable retrograde amnesia?

Answer 54

Episodic memory

Question 55

What is the pathology of cardiomyopathy in alcoholics?

Answer 55

Alcohol impairs ventricular function - Ca homeonstasis - Mitochondrial effects - Signal transduction Prolonged exposure leads to chronic inflammation/fibrosis of myofibrils

Question 56

What does electrolyte imbalance look like on an ECG?

Answer 56

Long QT

Question 57

What does dilated cardiomyopathy look like on an ECG?

Answer 57

Atrial and ventricular arrhythmias

Question 58

What does holiday heart look like on an ECG?

Answer 58

AF | SVT

Question 59

How long does it take a patient to recover from holiday heart?

Answer 59

24hrs

Question 60

Does alcohol related steatosis reverse?

Answer 60

Yes with cessation

Question 61

What causes hepatocyte damage in hepatitis?

Answer 61

Parenchymal inflammation

Question 62

What are the signs of foetal alcohol syndrome?

Answer 62

``` Epicanthal folds Flat nasal bridge Small palpebral fissures Railroad track ears Smooth philtrum Upturned nose Thin upper lip ```