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Year 2 Alcohol > Clinical effects of chronic alcoholism > Flashcards

Clinical effects of chronic alcoholism Flashcards

1
Q

What can be seen on the palms of an alcoholic?

A

Palmar erythema

Duputren’s contracture

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2
Q

Why do chronic alcoholics have palmar erythema?

A

Underlying liver cirrhosis

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

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3
Q

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

A

Caput medusae

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4
Q

What are caput medusae?

A

Prominent veins around the umbilicus

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5
Q

What causes caput medusae?

A

Portal hypertension

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6
Q

What are spider naevi?

A

Superficial veins across the chest

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7
Q

What is a subdural haematoma?

A

Bleeding in the subdural space

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8
Q

What causes subdural haematomas in alcoholic?

A

Falling over

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9
Q

What deficiency is seen in chronic alcoholics?

A

Thiamine deficiency

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10
Q

What is confabulation?

A

When a patient tries to mask memory loss in conversation

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11
Q

What can thiamine deficiency manifest as?

A

Wernicke-Korsakoff’s syndrome

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12
Q

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

A 
Abnormal shaky gait (ataxia)
Nystagmus
Ophthalmoplegia
General confusion
Disorientation
Memory loss
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13
Q

What type of pneumonia is common in alcoholics?

A

Aspiration pneumonia

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14
Q

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

A

Previous bouts of aspiration pneumonia

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15
Q

How does alcohol affect cardiac contraction?

A

Directly negative inotropic affect

Therefore HR increases

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16
Q

What effect does chronic alcoholism have on the heart?

A

Dilated cardiomyopathy

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17
Q

Why does wet beriberi cause heart failure?

A

Causes peripheral vasodilation and rapid arterio-venous shunting of blood

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18
Q

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

A

NADH

Stimulates lipid synthesis

Fatty liver

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19
Q

What causes acute fatty liver?

A

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

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20
Q

How does alcoholic steatohepatitis present?

A

Fever
Liver tenderness
Jaundice

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21
Q

What is seen on a microscopic level in alcoholic steatohepatitis?

A

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

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22
Q

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

A

Symptoms of portal hypertension

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23
Q

What causes cirrhosis?

A

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

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24
Q

What large veins are seen in portal hypertension?

A

Oesophageal varices

Splenomegaly

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25
Q

What causes gastritis during alcohol consumption?

A

Acute inflammatory cells (neutrophils)

26
Q

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

A

Mallory-Weiss tear

Boerhaave syndrome

27
Q

What is Boerhaave syndrome?

A

Oesophageal rupture

28
Q

What pathological change is seen in Barrett’s oesophagus?

A

Normal oesophageal squamous epithelium changes to columnar lined mucosa

29
Q

What is a varix?

A

An abnormal dilatation of a vessel

30
Q

What are some theories about acute pancreatitis?

A

Alcohol could be toxic to pancreatic acinar cells/ductal epithelial cells

Premature activation of digestive enzymes (results in autodigestion of pancreas)

31
Q

What is the digestion of fat called?

A

Saponification

32
Q

What is the pathology of chronic pancreatitis?

A

Secretion of proteinaous material into pancreatic ducts - eventually obstructing them

Scarring, sclerosis, pseudocyst formation with fat necrosis

33
Q

What is a pseudocyst?

A

Cysts are usually have an epithelial lining

A pseudocyst does not

34
Q

Why do pseudocysts occur in chronic pancreatitis?

A

result of tissue necrosis and degeneration

35
Q

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

A

ATP production
Normal nerve conduction
Maintenance of neural membranes

36
Q

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

A 
Poor intake
Decreased conversion to conenzyme
Reduced storage in fatty liver
Inhibited intestinal absorption
Increased metabolic demand
37
Q

What water soluble vitamins can chronic alcoholics be deficient in?

A

B and C

Folate and B 12 resulting in megaloblastic anaemia

38
Q

What is pellagra?

A

Vitamin B3 deficiency

39
Q

What signs/symptoms does a patient with pellagra have?

A

Dementia/Depressive psychosis
Photosensitive Dermatitis
Diarrhoea
Death

40
Q

What fat soluble vitamins can chronic alcoholics be deficient in?

41
Q

What is vitamin A responsible for?

A

Storage and synthesis of retinol binding protein

42
Q

What does vitamin A deficiency cause?

A

Reduced levels of plasma retinol

Leads to night blindness

43
Q

What minerals can chronic alcoholics be deficient in?

A

Calcium
Zinc
Selenium

44
Q

How is Ca secretion increased in chronic alcoholism?

A

Increased urinary secretion

45
Q

What are the alcohol limits for men and women?

A

14 units per week spread over 3 days

46
Q

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

A 
Breast
Bowel
Liver
Mouth/throat
Oesophageal
Stomach
47
Q

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

A

Morning after acute intoxication

48
Q

What is peripheral neuropathy caused by?

A

Thiamine deficiency

49
Q

What is compression neuropathy?

A

Temporary damage to myelin sheath

‘Saturday night palsy’

50
Q

What is the pathology of Wernicke-Korsakoff syndrome?

A

Thiamine deficiency and cytotoxic oedema in mamillary bodies

51
Q

What are the characteristic features of Korsakoff syndrome?

A

Profound anterograde amnesia

Variable retrograde amnesia

Confabulation

52
Q

What is confabulation?

A

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

53
Q

What is profound anterograde amnesia?

A

Unable to retian new info

54
Q

What is variable retrograde amnesia?

A

Episodic memory

55
Q

What is the pathology of cardiomyopathy in alcoholics?

A

Alcohol impairs ventricular function

  • Ca homeonstasis
  • Mitochondrial effects
  • Signal transduction

Prolonged exposure leads to chronic inflammation/fibrosis of myofibrils

56
Q

What does electrolyte imbalance look like on an ECG?

57
Q

What does dilated cardiomyopathy look like on an ECG?

A

Atrial and ventricular arrhythmias

58
Q

What does holiday heart look like on an ECG?

59
Q

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

60
Q

Does alcohol related steatosis reverse?

A

Yes with cessation

61
Q

What causes hepatocyte damage in hepatitis?

A

Parenchymal inflammation

62
Q

What are the signs of foetal alcohol syndrome?

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

Year 2 Alcohol (4 decks)

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