Symposium 2 - Alcohol Flashcards
What are the low-dose effects of alcohol?
Euphoria
Reduced anxiety
Relaxation
Sociability
What are the high dose effects of alcohol?
Intoxication Impaired attention/judgement Nystagmus Flushing Unsteadiness Disinhibition Mood instability
How is alcohol dependence diagnosed?
3 or more for >1mo of:
- Cravings/compulsions
- Difficulty controlling use
- Primacy
- Increased tolerance
- Withdrawal
- Persistence despite consequences
How is harmful alcohol use diagnosed?
Pattern of use to physical/mental health
Use >1mo or repeatedly over 12 months
What are the symptoms of alcohol withdrawal?
Tremor Weakness N+V Anxiety Seizures Confusion Agitation Death Delirium tremens
What is delirium tremens?
Withdrawal state:
Confusion, tremor, agitation, hallucinations, sleeplessness
5% mortality
48-72hrs after alcohol cessation
How does Delirium tremens cause death?
Cardiovascular collapse Infection Hyperthermia Seizures Self harm
What problems are associated with alcohol overuse?
Physical/mental health Relationships Employment Financial issues Legal issues
What mental health issues are associated with alcohol use?
Anxiety Depression Sleep disruption Morbid jealousy Alcoholic Hallucinosis Deliberate self-injury Suicidal thoughts
What cancers are associated with alcohol overuse?
Mouth
Oesophagus
Liver
What physical conditions are associated with alcohol overuse?
Brain damage - Korsakoffs/Wernicke's Chest infections Liver damage Neuropathy Immunosuppression Hypertension Gastritis/ulcers Pancreatitis Impotence/infertility
What are the neurological issues caused by alcohol overuse?
(Thiamine deficiency)
Wernicke’s Encephalopathy
Korsakoff’s Psychosis
What are the symptoms of Wernicke’s Encephalopathy?
Confusion
Ataxia
Ophthalmoplegia
Nystagmus
What are the symptoms of Korsakoff’s Psychosis?
Impairment of recent/remote memory to immediate recall
No cognitive impairment or anterograde amnesia
Impaired learning
Disorientation
Nystagmus
Ataxia
How can alcohol overuse impact relationships?
Aggression
Morbid jealousy
Poor parenting/neglect
Loss of friendships/social support
What screening tools are used for alcohol overuse?
CAGE
AUDIT
FAST
PAT (A&E)
What are the CAGE screening tool questions?
Have you tried to Cut down?
Have you felt Annoyed by criticism of your drinking?
Have you felt Guilty by drinking?
Have you felt the need to have an Eye-opener?
How does alcohol affect sleep?
Encourages sleep
Disrupts REM (poor long-term memory formation)
Blackouts
How does alcoholic hallucinosis present?
Typically insulting auditory hallucinations
How is alcohol overuse managed?
Practical advice Education Harm reduction Holistic approach Medication
What factors are associated with holistic management for alcoholism?
Support for patient and family Psychological help (e.g. CBT, group therapy) Social work input Skills training Community Support Inpatient or residential treatment Medication
What medications are used for alcoholism?
Thiamine (prevent Wernicke-Korsakoff)
Benzodiazepines (Manage withdrawal)
Disulfiram (Aversion/deterrant)
Anti craving drugs
What are the main roles of the liver?
Metabolise carbohydrates, fats, proteins Storeage Synthesis Collect waste Produce bile Metabolise drugs
When is AST > ALT?
Active alcohol consumption
Liver cirrhosis
How is fatty liver diagnosed?
USS Liver - hyperechoic
What are the CVS impacts of alcoholism?
Arrythmia Heart failure Thrombosis Vascualr disease HTN Dilated cardiomyopathy
How does alcohol affect the immune system?
Bone marrow suppression
Neutrophil chemotaxis
Increased cancer risk
What is the progression of alcohol related liver disease?
Normal liver Fatty liver (steatosis) Steatohepatitis Fibrosis Liver cirrhosis
What are the indications on examination of chronic alcohol use?
Elevated Gamma GT Elevated ferritin Low platelets Macrocytosis Enlarged smooth liver on AUSS
What are the symptoms of alcoholic hepatitis?
Fatty change Hepatomegaly Jaundice Abdominal pain Fever Hepatic decompensation
How is alcoholic hepatitis managed?
Glasgow Alcoholic Hepatitis score Steroids Infection management Nutrition Abstinence
What does a Glasgow Alcoholic Hepatitis score imply?
28 day survivial?
<9 = 87%
>9 = 46%
What are the main complications of cirrhosis?
Encephalopathy
Variceal haemorrhage
Ascites
Hepatocellular Carcinoma
How does abstinence effect cirrhosis survival rates?
5y survival if abstinent - 65%
Otherwise - 35%
