Medical and Dental implications of Alcohol abuse Flashcards
How is alcohol metabolised?
- 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
How is Alcohol Absorbed?
- 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
What is alcohol metabolised into?
Alcohol to acetaldehyde
Acetaldehyde to Acetate
Acetate to CO2 and water
What is blood alcohol concentration?
- Measurement of alcohol intoxication used for legal or medical purpose
- mass of alcohol per volume or mass of blood
What factors affect Blood alcohol concentration?
- Age
- Sex
- Body build
- Previous exposure to alcohol
- Type of drink
- Whether food is taken
- Drugs
What can a drug like Cimetidine do to blood alcohol concentration?
- Taken for acid reflux
- Delay gastric emptying and reduce absorption
How can antihistamines affect blood alcohol concentration?
- Increase gastric emptying and increase absorption of alcohol
Why do women absorb alcohol faster than men?
- Women have smaller blood volume
- Have lower levels of alcohol dehydrogenase in stomach
- More alcohol absorbed before its been metabolised
- Crosses placenta easily
How does time affect blood alcohol concentration?
- 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
How does tolerance in heavy drinkers affect alcohol absorption?
- Normal metabolism increases
- Microsomal ethanol oxidising system occurs
- In heavy drinkers with liver damage, enzyme production decrease
What is microsomal ethanol oxidising system?
- Alternate pathway of ethanol metabolism
- Occurs in smooth endoplasmic reticulum in oxidation of ethanol to acetaldehyde
- Increase after chronic alcohol consumption
How does intoxication affect a person?
- 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
What is the current legal driving limit in UK?
- 80mg/100ml
- Risk of road accident doubles at 50mg/100ml as judgment is impaired
How many mg of alcohol in blood per 100ml cause fatality?
- > 400mg/100ml commonly fatal
- Due to atrial fibrillation, respiratory failure and inhalation of vomit
How are genetics related to Alcohol problems?
- 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
What are the weekly safe alcohol limits you can do?
- 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
What are the risks of regular drinking?
- Many different health problems
- Cancers of mouth, throat and breast
- Conception of child issues
What medical problems to do with GI tract can occur due to chronic heavy drinking?
- 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
What medical problems relating to Heart can occur due to Chronic heavy drinking?
- Cardiomyopathy
- Cardiac arrhythmias
- Hypertension
-Increased triglycerides and LDL cholesterol
What other medical problems can occur due to Chronic heavy drinking?
- 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)
What is Macrocytosis?
- Larger than normal RBC
What is Thrombocytopenia?
- Deficiency of platelets in blood
- Slow clotting after injury
What is Leucopoenia?
- Body doesn’t have enough leukocytes in blood so fight disease
- Associated with low white blood cells
What are some oral problems in Chronic heavy drinking?
- 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
What is alcoholic liver disease?
- Liver damage caused by excess alcohol intake
- 20% of heavy drinkers will develop it
What can influence an individuals susceptibility to alcoholic liver disease?
- Environment and host factors play a part
Co-morbidity factors (envornment and host)
- Age
- Sex
- Viruses
- Drugs
- Nutrition
- Alcohol and metabolites obviously influence
What is included in the spectrum of Alcoholic liver disease?
- Normal liver
- Simple steatosis ( fatty liver)
- Steatohepatitis
- Cirrhosis (20%)
What is Steatohepatitis?
- 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
What is Steatosis?
- Fatty liver disease
- Common result of chronic alcohol ingestion
What is Cirrhosis?
- Scaring of the liver caused by long term liver damage
- Alcohol is most common cause (20% of heavy drinkers get it)
- Irreversible
What can Cirrhosis lead to?
- 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
How does liver disease affect dental aspects?
- 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
What occurs during drug metabolism in patients without liver damage?
- Heavy drinking induces liver damage
- May increase metabolism of some drugs
- More rapid destruction
- Reduced plasma conc
- Lack of effects
What is a Disulfiram reaction?
- 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
What drugs can cause GI bleeding in patients with liver damage?
- 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
Can patients who have Hepatitis C drink alcohol?
- No, they should abstain completely
- 25% patients with Hep C develop Cirrhosis
- Alcohol in any amount lead to rapid development of severe liver disease
How does Heroin interact with Alcohol?
Heroin - has sedative effect
How does Cocaine interact with Alcohol?
Cocaine - If taken at same time the new chemical produced similar to cocaine but has longer half life as alcohol prolongs effect of cocaine
How does Cannabis interact with Alcohol?
- Absorption of alcohol reduced
- Combination will increase sensation of confusion and disorientation making accidents more likely
How do Amphetamines interact with Alcohol?
- Increase impairment of judgement
How does Ecstasy interact with Alcohol?
- Increases intoxication but will reduce the potentially fatal fluid retention effect of ecstasy
What are the nutritional problems associated with alcoholism?
- 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
What heart diseases can alcoholism cause?
- Cardiomyopathy
- Cardiac arrhythmias
- Hypertension
- Stroke
- Protective effects
What is Cardiomyopathy?
- 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
How does cardiac function and alcohol affect women than men?
- Women develop cardiac problems with less alcohol and lower duration of consumption
How can cardiac arrhythmias be monitored?
- ECG changes can be marked
- Atrial fibrillation
- Prolonged Q-T interval
- Inverted T waves
- Heart block
- Ventricular arrhythmias
What is the correlation between Stroke and Alcohol?
- 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%
What is the correlation between hypertension and alcohol consumption?
- 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
What is portal hypertension?
- Elevated pressure in portal venous system
- Portal vein major vein that leads to liver
- Most common cause is cirrhosis
What is the effect of moderate alcohol intake on cardiovascular system?
- 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
Why does moderate alcohol intake reduce risk of CAD?
- 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
What are some other benefits of alcohol?
- Reduce incidence of gallstones
- Reduce macular degeneration
How is Oral cancer affected by Alcohol?
- 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
What kind of dental trauma can occur from alcohol misuse?
- Broken teeth
- Lost teeth
- Damage to soft tissues
- Lost dentures
- Interpersonal violence
- Falls
How can alcohol cause non-carious tooth surface loss?
- 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
Can Facial injuries from alcohol violence cause PTSD?
- Facial injuries can result in psychiatric morbidity
- PTSD
- Alcohol problems
- Viscous cycle
