Medical Impacts of Alcohol Flashcards
How many units of alcohol are in a spirit?
25ml
How many units of alcohol are in a small glass of wine?
125ml (2 units)
How many units of alcohol are in a large glass of wine?
250ml (3-4 units)
How many units of alcohol are in a bottle of wine?
10 units
What are the drinking recommendations?
14 units per week for both males and females
What is increasing due to alcohol related incidents?
Major admissions
What disease is rising because of alcohol?
Liver disease
What is the liver?
Major organ
Second biggest organ in body, 1.5 kg
How does the liver metabolise?
Material absorbed from G.I.T (gastroinstenial tract)
Storage of glycogen
Release of glucose
What does the liver do?
Protein synthesis (albumin Inactivation of hormones, drugs Excretion of waste Produce bile Produces clotting factors
What are the lobes of the liver?
Right lobe
Left lobe
Caudrate lobe
Quadate lobe
What does the ductus venousous do?
removes blood away from liver in baby
Where is bile produced?
The liver
Where is bile stored and concentrated?
Gallbladder
Where does bile pass out?
Through the cystic duct
What types of death involve alcohol?
Acute intoxication Chronic alcoholism Accidents Suicide Homicides
How is the post-mortem exam carried out for alcohol related deaths?
History
External
Internal
Samples (i.e. femoral artery/ vessels- 3 samples one in the right one in the left and another)
What is the world record for alcohol in blood?
> 1500mg/100ml of blood
What is acute alcohol intoxication?
Tolerance
0-100 dizzy and delightful- euphoria
What is the effects of 100-300 mg/100ml of blood?
Drunk and disorderly
What is the effects of >300 mg/100ml of blood?
Increasing danger of death
What does alcohol do to the brainstem?
Direct respiratory depressant effect
o Aspiration of vomit
o Cardiac arrhythmia- heart beats irregularly (can kill)
What deaths can be related to alcohol incidents?
Trauma- accidents
Fire deaths
Drowning
What are the post mortem findings for acute alcohol intoxication?
Usually only congestion of the lungs- oedema (swelling in lungs)
Vomit in airways
? Evidence of chronic alcoholism
Pre-existing disease- drug abuse
Traumatic injury- stabs, bruises, gun shot wounds
Burns?
What is chronic alcoholism?
Extremely potent drug
Widespread effects
All systems of the body are affected
What are the post mortem findings for death caused by chronic alcoholism?
General appearance- red face, bulbous nose, “beer belly”
Bruises- damage liver, damage clotting factors
Jaundice (yellowing)/spider naevi (more than 5 above level of heart=drink too much)/ gynaecomastia (male specifically, “man boobs”)
Ascites (swelling of absominal cavity)/ oedema
What is jaundice?
Accumulation of bilirubin in the skin
Breakdown product of haemoglobin (Hb)
Damaged liver cells (hepatocytes) do not function adequately
What is ascites?
Accumulation of fluid in the abdominal cavity
Due to portal hypertension and decreased proteins in the blood (albumin esp.)
What is spider naevi?
Skin lesion
Small central blood vessels with radiating smaller vessels
Affects the face, chest, and upper limbs
Sign of chronic liver disease
What can happen internally in the central nervous system?
Intracranial bleeding
Cerebellar atrophy
Wernicke-Korsakoff psychosis (nystagmus (eyes jumping about), ataxia (can’t walk properly), amesia (memory loss), confabulation (making up stories), hallucinations)
Delerium tremens (DTs)- shakes
What is intracranial bleeds?
Subdural haemorrhage
Extradural haemorrhage
Intracerebral haemorrhage
What is extradural haemorrhage?
o Damage to pterion o Space between the skull and the dura o Skull fractures- at what site? Pterion o What vessel is most likely to rupture? Middle meningeal artery o Usually a simple fall o Lucid interval o Neurosurgical drainage necessary o Alcoholics and elderly
What is intracerebral haemorrhage?
o Increased of haemorrhagic stroke if clotting is abnormal and the vessels are inherently weakened, blood loss
o Weaker, blood pressure rises
o Increased risk of hypertensive stroke
What can happen internally in the cardiovascular system?
o Increased in blood pressure o Is that good for the arteries? o Alcoholic cardiomyopathy Dilated chambers Enlargement of the cardiac myocytes Patchy fibrosis (thickening) in the interstitium
What can happen internally in the gastrointestinal system?
o Destroy stomach
o Gastric ulcer/ gastritis (swelling of stomach)
o Mallory-Weiss tear- tear between stomach and oesophagus
o Pancreatitis (acute/chronic)
o Malabsorption- don’t eat well
What is the pancreas dual purpose?
Exocrine and endocrine functions?
What are the exocrine functions of the pancreas?
99% of pancreas, many digestive enzymes, biocarbonate ions
What are the endocrine functions of the pancreas?
Islets of Langerhans- hormones, insulin, glucagon, somatosin
What are the acute effects of pancreatitis?
Direct toxic effects
Acute- pain/ nausea/ vomiting/ metabolic (Na+, Cl-, Bicarbonate ions)/ shock/ death
Acute- haemorrhagic/ necrotic pancreas
What are the chronic effects of pancreatitis?
Chronic- pain/ weight loss/ malabsorption/ diabetes
Chronic- fibrotic
What is the internal composition of the liver?
o Alcoholic hepatises- yellowing of eyes o Fatty degeneration o Cirrhosis- kills, destroys structure of liver, increases fibrotic tissue, increases blood pressure o Portal hypertension o Liver failure
What is alcoholic hepatitis?
Alcoholic hepatitis is hepatitis (inflammation of the liver) due to excessive intake of alcohol. It is usually found in association with fatty liver, an early stage of alcoholic liver disease, and may contribute to the progression of fibrosis, leading to cirrhosis.
What is fatty degeneration of the liver?
o Enlarged smooth liver
o Common cause of death
o ? Mechanism- metabolic imbalance
o Blood alcohol level low/absent- damage done in past
What is cirrhosis?
o Destroys structure of hepatocytes
o Younger patients
o Liver shrunk and nodular
What is portal hypertension?
o Restriction of blood flow o Increased blood pressure in and around liver o Back pressure- dilated veins o Oesophageal varices o Splenomegaly- back pressure into spleen, enlarged o Ruptured varices- bleed to death o Haematemesis- vomit blood o Black stools- bleeding in GIT tract o Haemorrhage- can be fatal
What are oseophageal varices?
Destroys architecture- blood cant go through the liver, causes increased blood pressure, causes an increased back pressure towards oesophagus
What causes liver failure?
o Signs of chronic liver failure o Jaundice o Ascites o Bleeding tendency o Infections o Cirrhosis/ splenomegaly/ varices/ malnutrition
