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PMHP > Medical and Dental implications of Alcohol abuse > Flashcards

Medical and Dental implications of Alcohol abuse Flashcards

1
Q

How is alcohol metabolised?

A
  • Alcohol is distributed throughout body water
  • Conc in liver is greater because blood comes directly to it from stomach and small intestine via portal vein
  • Very little alcohol enters body fat
  • 90% metabolised in liver
  • 2-5% excreted in sweat, urine or breath
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2
Q

How is Alcohol Absorbed?

A
  • It is water soluble
  • Slowly absorbed from stomach
  • More rapidly absorbed in small intestine
  • Rate of absorption quicker on empty stomach at conc of 20-30% (most quickly absorbed)
  • Spirits 40% delay gastric emptying and absorbed slower
  • Aerated alcohol e.g. champagne gets into system quicker
  • Food retards absorption
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3
Q

What is alcohol metabolised into?

A

Alcohol to acetaldehyde
Acetaldehyde to Acetate
Acetate to CO2 and water

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4
Q

What is blood alcohol concentration?

A
  • Measurement of alcohol intoxication used for legal or medical purpose
  • mass of alcohol per volume or mass of blood
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5
Q

What factors affect Blood alcohol concentration?

A
  • Age
  • Sex
  • Body build
  • Previous exposure to alcohol
  • Type of drink
  • Whether food is taken
  • Drugs
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6
Q

What can a drug like Cimetidine do to blood alcohol concentration?

A
  • Taken for acid reflux
  • Delay gastric emptying and reduce absorption
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7
Q

How can antihistamines affect blood alcohol concentration?

A
  • Increase gastric emptying and increase absorption of alcohol
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8
Q

Why do women absorb alcohol faster than men?

A
  • Women have smaller blood volume
  • Have lower levels of alcohol dehydrogenase in stomach
  • More alcohol absorbed before its been metabolised
  • Crosses placenta easily
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9
Q

How does time affect blood alcohol concentration?

A
  • Peaks 1 hour after drinking on empty stomach
  • Declines over next 4 hours
  • Removed at rate of 15mg/100ml/hr
  • Detectable levels still present for several hours
  • After 3 pints of beer, blood alcohol will be detectable in morning
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10
Q

How does tolerance in heavy drinkers affect alcohol absorption?

A
  • Normal metabolism increases
  • Microsomal ethanol oxidising system occurs
  • In heavy drinkers with liver damage, enzyme production decrease
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11
Q

What is microsomal ethanol oxidising system?

A
  • Alternate pathway of ethanol metabolism
  • Occurs in smooth endoplasmic reticulum in oxidation of ethanol to acetaldehyde
  • Increase after chronic alcohol consumption
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12
Q

How does intoxication affect a person?

A
  • Mild sedative
  • Mild anaesthetic
  • Stimulates dopamine and serotonin
  • Sense of wellbeing relaxation and disinhibition
  • 100mg/100ml become elated and aggressive
  • 200mg/100ml slurred speech and unsteadiness
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13
Q

What is the current legal driving limit in UK?

A
  • 80mg/100ml
  • Risk of road accident doubles at 50mg/100ml as judgment is impaired
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14
Q

How many mg of alcohol in blood per 100ml cause fatality?

A
  • > 400mg/100ml commonly fatal
  • Due to atrial fibrillation, respiratory failure and inhalation of vomit
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15
Q

How are genetics related to Alcohol problems?

A
  • Genetic predisposition to development of alcohol problems
  • 4x increased risk of alcoholism in primary relatives
  • More common in monozygotic twin siblings
  • Adopted away children of alcoholics 4x increased risk
  • 40% environment 60% genetics
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16
Q

What are the weekly safe alcohol limits you can do?

A
  • Don’t drink more than 14units a week on regular basis (men and women)
  • If do drink 14units regularly a week then spread out evenly over 3 or more days
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17
Q

What are the risks of regular drinking?

A
  • Many different health problems
  • Cancers of mouth, throat and breast
  • Conception of child issues
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18
Q

What medical problems to do with GI tract can occur due to chronic heavy drinking?

A
  • Acute gastritis
  • Liver problems
  • GI bleeding
  • Oral, oesophageal, stomach, bowel cancer
  • Pancreatic disease
  • Obesity and malnutrition
  • Vitamin deficiency-folic acid, Vits B1, B2, B6, E, B1 and D
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19
Q

What medical problems relating to Heart can occur due to Chronic heavy drinking?

A
  • Cardiomyopathy
  • Cardiac arrhythmias
  • Hypertension
    -Increased triglycerides and LDL cholesterol
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20
Q

What other medical problems can occur due to Chronic heavy drinking?

A
  • Traumatic injuries
  • Chest
  • Gynaecological problems
  • Obstetric problems
  • Blood (macrocytosis, thrombocytopenia, Leucopenia)
  • Acute or chronic myopathy (skeletal muscle disorder)
  • Osteoporosis
  • Osteomalacia
  • Bleeding
  • Poor wound healing
  • Affects drugs
  • Patients with hep C
  • Immune system
  • Mental health
  • Renal
  • Nervous system (epilepsy)
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21
Q

What is Macrocytosis?

A
  • Larger than normal RBC
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22
Q

What is Thrombocytopenia?

A
  • Deficiency of platelets in blood
  • Slow clotting after injury
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23
Q

What is Leucopoenia?

A
  • Body doesn’t have enough leukocytes in blood so fight disease
  • Associated with low white blood cells
24
Q

What are some oral problems in Chronic heavy drinking?

A
  • Oral cancer-concurrent in tobacco use
  • Oral ulceration
  • Glossitis (tongue is inflamed and swollen)
  • Angular cheilitis
  • Gingivitis
  • Nutritional deficiency
  • Dental neglect
  • Dental trauma due to chaotic lifestyle
  • Lost dentures
  • Salivary gland enlargement (Sialosis)
  • Xerostomia
  • Poor wound healing and osetomyelitis
  • Suppression of immune system by alcohol
  • Dental erosion
  • Bruxism
25
Q

What is alcoholic liver disease?

A
  • Liver damage caused by excess alcohol intake
  • 20% of heavy drinkers will develop it
26
Q

What can influence an individuals susceptibility to alcoholic liver disease?

A
  • Environment and host factors play a part

Co-morbidity factors (envornment and host)
- Age
- Sex
- Viruses
- Drugs
- Nutrition

  • Alcohol and metabolites obviously influence
27
Q

What is included in the spectrum of Alcoholic liver disease?

A
  • Normal liver
  • Simple steatosis ( fatty liver)
  • Steatohepatitis
  • Cirrhosis (20%)
28
Q

What is Steatohepatitis?

A
  • Liver disease characterised by hepatic steatosis, inflammation and increased hepatocyte death
  • Usually intermediate stage between simple fatty liver and cirrhosis
  • Increased risk of liver failure and death if associated with hepatic fibrosis or cirrhosis
29
Q

What is Steatosis?

A
  • Fatty liver disease
  • Common result of chronic alcohol ingestion
30
Q

What is Cirrhosis?

A
  • Scaring of the liver caused by long term liver damage
  • Alcohol is most common cause (20% of heavy drinkers get it)
  • Irreversible
31
Q

What can Cirrhosis lead to?

A
  • Morbidity is common
  • Jaundice,
  • Ascites,
  • Bleeding,
  • Cachexia,
  • Infections,
  • Encephalopathy
  • 90% 5 year survival rate if stop drinking
  • 60% 5year survival rate if don’t
  • Liver damage and death within 10years
32
Q

How does liver disease affect dental aspects?

A
  • Reduced synthesis of clotting factors in damaged liver
  • Thrombocytopenia due to splenomegaly associated with portal hypertension
  • Platelet aggregation reduced
  • Prolonged bleeding
  • Also reduced absorption of Vit K II, VII, IX, X
  • Megakaryocyte maturation reduced leading to fewer platelets
  • Prolonged bleeding
33
Q

What occurs during drug metabolism in patients without liver damage?

A
  • Heavy drinking induces liver damage
  • May increase metabolism of some drugs
  • More rapid destruction
  • Reduced plasma conc
  • Lack of effects
34
Q

What is a Disulfiram reaction?

A
  • Disulfiram (Antabuse) inhibits alcohol dehydrogenase which usually converts acetaldehyde to acetate
  • Acetaldehyde builds up and nausea and vomiting occur if alcohol is taken
  • Used in alcohol treatment and other drugs can cause this reaction like Metronidazole, Cephalosporins, Ketoconazole
  • If large amounts of alcohol are taken then cardiac arrhythmias and hypotensive collapse can occur
35
Q

What drugs can cause GI bleeding in patients with liver damage?

A
  • Aspirins and NSAIDs are irritant to gastric mucosa
  • Alcohol also gastric irritant
  • Clotting may be deranged due to liver disease so exacerbates the GI Bleeding
36
Q

Can patients who have Hepatitis C drink alcohol?

A
  • No, they should abstain completely
  • 25% patients with Hep C develop Cirrhosis
  • Alcohol in any amount lead to rapid development of severe liver disease
37
Q

How does Heroin interact with Alcohol?

A

Heroin - has sedative effect

38
Q

How does Cocaine interact with Alcohol?

A

Cocaine - If taken at same time the new chemical produced similar to cocaine but has longer half life as alcohol prolongs effect of cocaine

39
Q

How does Cannabis interact with Alcohol?

A
  • Absorption of alcohol reduced
  • Combination will increase sensation of confusion and disorientation making accidents more likely
40
Q

How do Amphetamines interact with Alcohol?

A
  • Increase impairment of judgement
41
Q

How does Ecstasy interact with Alcohol?

A
  • Increases intoxication but will reduce the potentially fatal fluid retention effect of ecstasy
42
Q

What are the nutritional problems associated with alcoholism?

A
  • Alcohol very calorific i.e. 6 pints of beer = 500Kcals
  • Alcoholics generally malnourished
  • General neglect
  • Substitution of food with alcohol
    Deficiencies of
  • Thiamine-beriberi,Wernicke’s encephalopathy
  • Folic acid-macrocytosis
  • Vitamin C-scurvy
43
Q

What heart diseases can alcoholism cause?

A
  • Cardiomyopathy
  • Cardiac arrhythmias
  • Hypertension
  • Stroke
  • Protective effects
44
Q

What is Cardiomyopathy?

A
  • Degenerative heart disease with no coronary artery disease, has various aetiologies
  • Well established complication of chronic alcohol abuse
  • Most cases asymptomatic
  • Can lead to arrhythmias, cardiomegaly and congestive heart failure (dyspnea and peripheral oedema)
  • May be due to accumulation of fatty acids ethyl esters (FAEE) in mitochondria)
  • Abstain from alcohol
45
Q

How does cardiac function and alcohol affect women than men?

A
  • Women develop cardiac problems with less alcohol and lower duration of consumption
46
Q

How can cardiac arrhythmias be monitored?

A
  • ECG changes can be marked
  • Atrial fibrillation
  • Prolonged Q-T interval
  • Inverted T waves
  • Heart block
  • Ventricular arrhythmias
47
Q

What is the correlation between Stroke and Alcohol?

A
  • Light to moderate alcohol consumption decreases risk of Ischaemic stroke
  • Consumption of 5 of more drinks per day increases risk of stroke by 250-450%
48
Q

What is the correlation between hypertension and alcohol consumption?

A
  • Hypertension is risk factor for stroke
  • Generally can cause low grade hypertension
  • Chronic intake of 30g/day or more of alcohol causes it
  • Hypertension can be reversed within 2-3 weeks of cessation of alcohol intake even in heavy drinkers
  • Can lead to portal hypertension
49
Q

What is portal hypertension?

A
  • Elevated pressure in portal venous system
  • Portal vein major vein that leads to liver
  • Most common cause is cirrhosis
50
Q

What is the effect of moderate alcohol intake on cardiovascular system?

A
  • Moderate alcohol intake associated with decreased risk of coronary artery disease (CAD) in men and women
  • Relative risk of CAD for non drinkers is 1 but for moderate drinkers is 0.5
  • Moderate is 1-2 units of alcohol 2-3times per week
  • Benefits older men and post-menopausal women in particular
51
Q

Why does moderate alcohol intake reduce risk of CAD?

A
  • Decreases atherogenic plaques in humans and experimental animals
  • Alcohol increases HDL cholesterol
  • Also associated with reduced mortality following MI if drinking moderately in year prior
52
Q

What are some other benefits of alcohol?

A
  • Reduce incidence of gallstones
  • Reduce macular degeneration
53
Q

How is Oral cancer affected by Alcohol?

A
  • Ethanol metabolite acetaldehyde promotes tobacco initiated tumours
  • Damages DNA and alters oncogene production
  • Alcohol increases absorption of carcinogenic substances across oral mucosa
  • Oral mucosa most likely thinned due to nutritional deficiency making it easier for absorption
54
Q

Can Facial injuries from alcohol violence cause PTSD?

A
  • Facial injuries can result in psychiatric morbidity
  • PTSD
  • Alcohol problems
  • Viscous cycle
54
Q

What kind of dental trauma can occur from alcohol misuse?

A
  • Broken teeth
  • Lost teeth
  • Damage to soft tissues
  • Lost dentures
  • Interpersonal violence
  • Falls
55
Q

How can alcohol cause non-carious tooth surface loss?

A
  • Alcohol very acidic
  • Gastro-oesophageal reflux disease (GORD) can occur as acid in alcohol directly relaxes the oesophageal sphincter
  • Vomiting
  • Bruxism can also be paired with it
  • Restorations are difficult until problem is controlled

PMHP (11 decks)

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