Medical Consequences of Alcohol Excess

Question 1

What are the alcohol consumption guidelines?

Answer 1

Men and women should notregularly drink more than 14 units of alcohol a week

Ideally, this should be spread evenly over three days or more

Drinkers should limit the amount they consume on single occasions, and intersperse drinking alcohol with eating food and drinking water

Pregnant women should avoid drinking altogether

Question 2

How to calculate units of alcohol?

Answer 2

(ABV % x volume)/1000

Question 3

Effects of excess alcohol consumption?

Answer 3

Acute effects:
CNS - accidents and violence
GI - oesophagitis, gastritis/ulceration, acute pancreatitis
Respiratory - overdose and aspiration

Chronic effects:
GI - stomach, liver and pancreas (insulin resistance) affected
CVS - hypertension, cardiomyopathy, MI and stroke
CNS - neuropathies, cerebellar degeneration, dementia, Wernicke-Korsakoff’s syndrome
Haematological - anaemia and bone marrow depression
Musculoskeletal - proximal myopathy and osteoporosis
Endocrine
Dermatologic
Reproductive

Question 4

Underage drinking effects on brain?

Answer 4

Youths with alcohol-use disorders have smaller hippocampal memory areas than non-drinkers do; teens with alcohol-use disorders have greater activity in areas of the brain linked to:
Reward
Desire
Positive Effect
Episodic recall in response to alcohol advertisements

Question 5

What is foetal alcohol syndrome?

Answer 5

Exposure in utero growth deficiency, mental retardation/intellectual impairment, attentional learning disabilities and behavioural problems

Question 6

What are the effects of alcohol on the liver?

Answer 6

Alcohol must undergo metabolism

Alcohol-related liver disease:
Cirrhosis
Alcoholic hepatitis

Question 7

Substances in the liver involved with alcohol metabolism?

Answer 7

Alcohol dehydrogenase
Aldehyde dehydrogenase
Ketone bodies
Catalase
Cytochrome p450 2E1
Phase 2 enzymes

Question 8

Mechanisms of alcoholic liver damage?

Answer 8

Gut permeability leads to endotoxemia and Kupffer cell activation; these produce TNF-alpha, leading to inflammation

ADH can produce acetaldehyde, which can cause inflammation, hepatocyte injury and fibrosis (stellate cell activation)

CYPCE1 causes oxidative stress, leading to stellate cell activation and fibrosis

Malnutrition results in impaired regeneration

Question 9

Spectrum of alcohol-related liver disease?

Answer 9

Fatty liver steatosis can progress to:
Alcoholic hepatitis (steatohepatitis), which can then cause cirrhosis and hepatocellular carcinoma
There can be direct progression to cirrhosis and HCC

Question 10

Signs of alcoholic liver disease?

Answer 10

Malaise, nausea, fever and sepsis
Hepatomegaly and jaundice

Encephalopathy
Ascites
Renal failure
Death

Question 11

Signs of chronic liver disease on examination?

Answer 11

Spider naevi, fetor breath and encephalopathy

Synthetic dysfunction leads to prolonged prothrombin time and hypoalbuminaemia

Portal hypertension causes caput medusae, hypersplenism and thrombocytopaenia (pancytopaenia is common in men)

Question 12

Clinical spectrum of alcoholic liver disease?

Answer 12

Malaise
Nausea
Hepatomegaly
Fever
Jaundice
Sepsis
Encephalopathy
Ascites
Renal Failure
Death

Question 13

Grading of cirrhosis?

Answer 13

Childs-Turcotte-Pugh

Model for end-stage liver disease (MELD)

Maddrey discriminant function:
DF= 4.6 x (PT patient – PT cont) + [Serum bilirubin (µmol/l)  17.1]

Score >32 correlates 45% mortality at 28 day

Glasgow alcoholic hepatic score

Question 14

Medications for Alcoholic hepatitis?

Answer 14

In severe AH, pentoxifylline no benefit

Prednisolone beneficial in short term mortality but not medium or long-term outcome