FN: Alcoholism

Question 1

Hepatic effects

Answer 1

􏰀 Fatty liver → hepatitits → cirrhosis

􏰀 AST:ALT >2, ↑ GGT

Question 2

GIT effects

Answer 2

􏰀 Gastritis, erosions
􏰀 PUD
􏰀 Varices
􏰀 Pancreatitis
􏰀 Carcinoma

Question 3

CNS effects

Answer 3

􏰀 Poor memory / cognition
􏰀 Peripheral polyneuropathy (mainly sensory)
􏰀 Wernicke’s encephalopathy
􏰁 Confusion
􏰁 Ophthalmoplegia (nystagmus, LR palsy) 􏰁 Ataxia
􏰀 Korsakoff’s: amnesia → confabulation
􏰀 Fits, falls

Question 4

Heart

Answer 4

􏰀 Arrhythmias: e.g. AF
􏰀 Dilated cardiomyopathy
􏰀 ↑BP

Question 5

Blood

Answer 5

Raised MCV

Folate deficiency - anaemia

Question 6

Diagnosis: CAGE

Answer 6

􏰀 Cut down?
􏰀 Annoyed by people’s criticisms
􏰀 Guilty about drinking
􏰀 Eye opener?

Question 7

Withdrawal
Signs
Treatment

Answer 7

􏰀 10-72h after last drink
􏰀 Consider in new ward pt (􏰄3d)  ̄c acute confusion
􏰀 Signs
􏰁 ↑HR, ↓BP, tremor
Alcoholic Hepatitis
Presentation
􏰀 Anorexia
􏰀 D/V
􏰀 Tender hepatomegaly
􏰀 Ascites
􏰀 Severe: Jaundice, bleeding, encephalopathy
Ix
􏰀 Bloods: ↑MCV, ↑GGT, AST:ALT>2
􏰀 Ascitic tap
􏰀 Abdo US + PV duplex
Rx
􏰀 Stop EtOH
􏰀 Rx withdrawal
􏰀 High dose B vitamins: Pabrinex
􏰀 Optimise nutrition
􏰀 Daily wt., LFT, U+E, INR
􏰀 Mx complications of failure
Prognosis
􏰁 Confusion, fits, hallucinations: esp formication (DTs)
􏰀 Rx
􏰁 Tapering regimen of chlordiazepoxide PO / lorazepam IM
􏰁 Thiamine

Question 8

Management

Answer 8

􏰀 Group therapy or self-help (e.g. AA)
􏰀 Baclofen: ↓ cravings
􏰀 Acamprosate: ↓ cravings
􏰀 Disulfiram: aversion therapy