Symposium 2 - Alcohol Flashcards
What are infects of alcohol intoxication?
Impaired attention and judgement, unsteadiness, flushing, nystagmus, mood instability, disinhibition, slurring, stupor, unconsciousness
What is ‘harmful use’ of alcohol?
3 or more of the following for >1 month or repeatedly over 12 months
What symptoms are present in alcohol withdrawal state?
Tremor, weakness, nausea, vomiting, anxiety, seizures, confusion, agitation, death, delirium tremens
What problems are associated with alcohol?
Physical health, mental health, relationships, employment, financial, legal
How can alcohol affect mental health?
Anxiety, depression, sleep disturbance, morbid jealously, alcoholic hallucinosis, deliberate self-injury, suicidal thoughts/acts
List physical effects of alcohol.
Brain damage Risk of infection Hepatitis/cirrhosis Nerve damage Poor diabetes control Loss of muscle Cardiomyopathy Ulcers Gastritis Impotence infertility
What changes are seen on imaging of an alcoholic brain?
Marked cerebral atrophy
What are signs of Wernicke’s encephalopathy?
Confusion., ataxia, opthalmoplegia, nystagmus
What are signs of Korsakoff’s psychosis?
Prominent impairment of memory, no general cognitive impairment, impaired learning, nystagmus and ataxia
What causes Wernicke’s encephalopathy and Korsakoff’s psychosis?
Thiamine deficiency
What screening tools are used for determine alcohol problems?
CAGE (2 or more = likely problem)
AUDIT
FAST
PAT (used in A&E)
How do you mange alcoholics?
Practical advice
Education
Harm reduction
Holistic/bio-psycho-social approach
What medication can be given to alcoholics?
Give thiamine to prevent Wernicke-Korsakoff syndrome
Disulfiram (aversion/deterrent)
How do you manage alcohol withdrawal pharmacologically?
Benzodiazepines (chlordiazepoxide)
What anti-craving medications can be given to alcoholics?
Acamprosate (cameral), naltrexone, nalmefene (baclofen)
How do you diagnose fatty liver?
USS
What do you expect to see for AST and ALT results in an alcoholic?
AST higher
What can fatty liver progress to?
Alcoholic hepatitis
and cirrhosis on continued ingestion
What is acute alcoholic hepatitis?
Severe inflammation of the liver
What are signs of poor prognosis/high mortality with fatty liver?
Bilirubin >125
INR >1.5, WCC> 15, Urea >5, Age >50 years
What are varices?
Secondary to cirrhosis and PHT
Where can varices be found?
Oesophagus, stomach, abdominal wall, rectum
What is the risk of ongoing alcohol abuse with varices?
Bleeding
What is treatment for Hepatocellular cancer?
TACE, RFA, MWA, Surgery, transplantation, chemo
What amount of alcohol /day increases the risk of oesophageal SCC?
> 30g/day
List effects of alcohol on heart?
Weakens muscles --> dilated cardiomyopathy Acetaldehyde affect walls High BP Vascular disease Thrombosis Arrhythmia Heart failure
How does alcohol affect bone marrow?
Chemotactic function of neutrophils
Weakens bone marrow
Reduces platelets
Poor response to injury/infection
What is delirium tremens?
Starts two/three days after stopping alcohol - can be fatal
