effects of alcohol on the body

Question 1

What are the common signs found on general examination in chronic alcohol abusers?

Answer 1

• Palmar erythema
• Dupuytren’s contracture
• Caput medusae
• spider naevi

Question 2

What condition common to alcoholic patients is palmar erythema associated with?

Answer 2

liver cirrhosis

Question 3

Dupuytren’s contracture is caused by fibrosis of the _____ _____ of the fingers

Answer 3

flexor tendons

Question 4

Caput medusae arise due to ____ _____

Answer 4

portal hypertension

Question 5

What is subdural haematoma?

Answer 5

bleeding in the subdural space of the brain common in alcohilics

Question 6

Ataxia (an abnormally shaky gait) and abnormal eye movements are characteristic of _______ ___________

Answer 6

Wernicke’s syndrome

Question 7

Loss of memory, often coupled with attempts to mask it (confabulation), is known as _____ _______

Answer 7

Korsakoff’s syndrome

Question 8

What is the main site of infection in aspiration pneumonia?

Answer 8

right lower lobe

Question 9

What effects does chronic alcohol abuse have on the heart? How is it brought on?

Answer 9

dilated cardimyopathy

-alcohol is a negative inotrope - it reduces contractility. This is compensated by increase heart rate

Question 10

How does alcohol ingestion affect fat metabolism in the liver?

Answer 10

• increased peripheral free fatty acid is delivered to the liver
• NAD is converted by alcohol to NADH, which stimulates lipid synthesis
• mitochondrial oxidation of free fatty acids is reduced by alcohol
• transport of fat out of hepatocytes is reduced (due to impaired intracellular tubulin)

Question 11

What is the presentation of acute alcoholic steatohepatitis?

Answer 11

• fever
• liver tenderness
• jaundice

Question 12

What is the histopathology of alcoholic steatohepatitis?

Answer 12

• acute inflammatory cell infiltration
• cellular steatosis
• hepatocyte ballooning
• Mallory’s hyaline (pink inclusion in cytoplasm)

Question 13

What is Boerhaave syndrome?

Answer 13

Oesophageal rupture resulting from protracted vomiting

Question 14

The tearing of the eosophageal muocsa is known as…

Answer 14

Mallory-Weiss tear

Question 15

What is Barret’s oesophagus?

Answer 15

change of the normal squamous epithelium to the columnar lined mucosa in response to repeat insult from gastric contents

Question 16

Oesophageal varice formation is reversible if treated before rupture (T/F)

Answer 16

False

-treatment is symptomatic - e.g. banding upon rupture

Question 17

Fat necrosis, scarring and pseudocyst formation in the pancreas arises due to ____ _____

Answer 17

chronic pancreatitis

Question 18

How do pseudocysts differ from cysts?

Answer 18

cysts are lined by epithelial cells

Question 19

What is the pathophysiology of alcohol-induced peripheral neuropathy?

Answer 19

• burning pain and weakness are present

- due to direct damage to peripheral nerves and thiamine deficiency

Question 20

Thiamine deficiency resulting in cytotoxic oedema in Mamillary bodies is…

Answer 20

Wernicke’s Encephalopathy

Question 21

Cerebral atropnhy resulting from Wernicke’s syndrome is…

Answer 21

Korsakoff syndrome

Question 22

What are the characterisitcs of Korsakoff syndrome?

Answer 22

• Anterograde amniesia (no retention of new information)
• Retrograde amnesia (episodic memory)
• Confabulation

Question 23

How does chronic alcohol consumption result in Cardiomyopathy?

Answer 23

• Alcohol imparis ventricular function by impairing Ca homeostasis and mitochondrial function
• Chronic inflammation leads to fibrosis of myofibrils
• negative inotropic effect leads to compensatory increased contraction rate, causing dilated cardiomyopathy

Question 24

How does alcohol cause arrhythmias?

Answer 24

• direct negative inotropic effect

- dilated caridomyopathy leads to atrial and ventricular arrhythmias

Question 25

Alcohol related Steatohepatitis is irreversible (T/F)

Answer 25

False

reversible with cessation of drinking

Question 26

What are the common complications associated with alcoholic hepatitis?

Answer 26

Renal failure
Bleeding
Infections

Question 27

What is the cause of Hepatic Encephalopathy?

Answer 27

Ammonia

• portosystemic shunting through collaterals results in failure to clear toxins
• ammonia crosses the BBB

Question 28

What is the treatment for Hepatic encephalopathy?

Answer 28

Beta blockers
Lactulose
Rifaximim
TIPS (transjugular intrahepatic portosystemic shunt)

Question 29

Which metabolite of ethanol is carcinogenic?

Answer 29

Acetaldehyde

Question 30

How does acetladehyde make its way into systemic circulation?

Answer 30

Excess alcohol use chronically leads to circumvention of the portal circulation. Alcohol is metabolised by ADH in stomach and UGI mucosa. no Aldehyde Dehydrogenase is present, thus acetaldehyde remains. unmetabolised

Question 31

What drugs can be used to support reduction of alcohol consumption?

Answer 31

Acamprosate - reduces cravings
Naltrexone - reduced desire for alcohol
Disulfiram - aversion therapy
Nalmefene - opioid antagonist