effects of excess alcohol

Question 1

how many units max should the public have in a week ?

Answer 1

14 units

Question 2

acute effects of alcohol consumption ?

Answer 2

CNS:

• accidents
• violence

GI:

• oesophagitis
• gastritis/ulceration
• acute pancreatitis

Resp:

• overdose
• aspiration

Question 3

chronic effects ? part I

Answer 3

GI:

• stomach
• liver
• pancreas

CV:

• HPT
• cardiomyopathies
• MI
• stroke

CNS:

• neuropathies
• cerebellar degeneration
• dementia
• Wernicke-Korsakoff’s syndrome

Question 4

chronic effects ? part II

Answer 4

Haematologic:

• anaemia
• bone marrow suppression

MSK:

• proximal myopathy
• oestoporesis

Endocrine

Dermatologic

Reproductive

Question 5

what is foetal alcohol syndrome ?

Answer 5

• when a mother drinks alcohol during the pregnancy and the foetus is exposed to alcohol in utero
• 7-14 drinks a week can cause moderate damage

Question 6

what does foetal alcohol syndrome consist of ?

Answer 6

growth deficiency

intellectual impairment

attentional learning disabilities

behavioural problems

Question 7

what are signs of chronic liver disease ?

Answer 7

• stigmata: spider naevi, fetor, encephalopathy
• synthetic dysfunction
• prolonged prothrombin time, hypoalbuminaemia

-portal hypertension:
caput medusa, hypersplenism , thrombocytopenia

Question 8

how is alcohol metabolised ?

Answer 8

ethanol is broken down into acetaldehyde via: 
1. CYP2E1
2. catalase 
3. alcohol dehydrogenase 
in the cytosol 

acetaldehyde is further broken down into acetate via:
aldehyde dehydrogenase

Question 9

what is the most dangerous form of alcohol ?

Answer 9

acetaldehyde

(this one causes direct injury to hepatocytes, can cause direct inflammation to the liver, it also activates stellate cells (increasing the amount of fibrosis in the liver))

Question 10

what metabolic pathway of ethanols breaking down is the most dangerous ?

Answer 10

cytochrome P2E1

-causes a lot of oxidative stress (more cell injury)

Question 11

what is the most common grading system for cirrhosis ?

Answer 11

child - pugh

Question 12

what is clinically relevant alcoholic hepatitis ?

Answer 12

essential features:

• recent excess alcohol
• bilurbin > 80mol/l
• exclusion of other liver disease
• AST < 500 (AST:ALT ratio > 1.5)

characteristics features:
hepatomegaly, fever, leucocytosis, hepatic bruit

Question 13

what is a score to calculate mortality in acute hepatitis ?

Answer 13

glasgow alcoholic hepatitis score

Question 14

treatment for acute hepatitis ?

Answer 14

to stop drinking completely