Symposium 2 - Alcohol

Question 1

What are infects of alcohol intoxication?

Answer 1

Impaired attention and judgement, unsteadiness, flushing, nystagmus, mood instability, disinhibition, slurring, stupor, unconsciousness

Question 2

What is ‘harmful use’ of alcohol?

Answer 2

3 or more of the following for >1 month or repeatedly over 12 months

Question 3

What symptoms are present in alcohol withdrawal state?

Answer 3

Tremor, weakness, nausea, vomiting, anxiety, seizures, confusion, agitation, death, delirium tremens

Question 4

What problems are associated with alcohol?

Answer 4

Physical health, mental health, relationships, employment, financial, legal

Question 5

How can alcohol affect mental health?

Answer 5

Anxiety, depression, sleep disturbance, morbid jealously, alcoholic hallucinosis, deliberate self-injury, suicidal thoughts/acts

Question 6

List physical effects of alcohol.

Answer 6

Brain damage
Risk of infection
Hepatitis/cirrhosis
Nerve damage
Poor diabetes control
Loss of muscle
Cardiomyopathy
Ulcers
Gastritis
Impotence
infertility

Question 7

What changes are seen on imaging of an alcoholic brain?

Answer 7

Marked cerebral atrophy

Question 8

What are signs of Wernicke’s encephalopathy?

Answer 8

Confusion., ataxia, opthalmoplegia, nystagmus

Question 9

What are signs of Korsakoff’s psychosis?

Answer 9

Prominent impairment of memory, no general cognitive impairment, impaired learning, nystagmus and ataxia

Question 10

What causes Wernicke’s encephalopathy and Korsakoff’s psychosis?

Answer 10

Thiamine deficiency

Question 11

What screening tools are used for determine alcohol problems?

Answer 11

CAGE (2 or more = likely problem)

AUDIT
FAST
PAT (used in A&E)

Question 12

How do you mange alcoholics?

Answer 12

Practical advice
Education
Harm reduction
Holistic/bio-psycho-social approach

Question 13

What medication can be given to alcoholics?

Answer 13

Give thiamine to prevent Wernicke-Korsakoff syndrome

Disulfiram (aversion/deterrent)

Question 14

How do you manage alcohol withdrawal pharmacologically?

Answer 14

Benzodiazepines (chlordiazepoxide)

Question 15

What anti-craving medications can be given to alcoholics?

Answer 15

Acamprosate (cameral), naltrexone, nalmefene (baclofen)

Question 16

How do you diagnose fatty liver?

Answer 16

USS

Question 17

What do you expect to see for AST and ALT results in an alcoholic?

Answer 17

AST higher

Question 18

What can fatty liver progress to?

Answer 18

Alcoholic hepatitis

and cirrhosis on continued ingestion

Question 19

What is acute alcoholic hepatitis?

Answer 19

Severe inflammation of the liver

Question 20

What are signs of poor prognosis/high mortality with fatty liver?

Answer 20

Bilirubin >125

INR >1.5, WCC> 15, Urea >5, Age >50 years

Question 21

What are varices?

Answer 21

Secondary to cirrhosis and PHT

Question 22

Where can varices be found?

Answer 22

Oesophagus, stomach, abdominal wall, rectum

Question 23

What is the risk of ongoing alcohol abuse with varices?

Answer 23

Bleeding

Question 24

What is treatment for Hepatocellular cancer?

Answer 24

TACE, RFA, MWA, Surgery, transplantation, chemo

Question 25

What amount of alcohol /day increases the risk of oesophageal SCC?

Answer 25

> 30g/day

Question 26

List effects of alcohol on heart?

Answer 26

Weakens muscles --> dilated cardiomyopathy
Acetaldehyde affect walls
High BP
Vascular disease
Thrombosis
Arrhythmia
Heart failure

Question 27

How does alcohol affect bone marrow?

Answer 27

Chemotactic function of neutrophils
Weakens bone marrow
Reduces platelets
Poor response to injury/infection

Question 28

What is delirium tremens?

Answer 28

Starts two/three days after stopping alcohol - can be fatal