Symposium 2- Alcohol

Question 1

What are the acute effects of alcohol?

Answer 1

In low doses:
-Euphoria
-Reduced anxiety
-Relaxation
-Sociability
In high doses:
-Intoxication
-Unsteadiness
-Impaired attention and judgement
-Flushing
-Nystagmus
-Disinhibition
-Slurring
-Stupor 
-Unconsciousness

Question 2

How is harmful alcohol use defined?

Answer 2

A pattern of use causing physical or mental harm >1 month or repeatedly over 12 months

Question 3

How is alcohol dependence defined?

Answer 3

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

• Cravings/compulsions to drink
• Difficulty controlling use
• Primacy
• Increased tolerance
• Physiological withdrawal on reduction
• Persistence despite harmful consequences

Question 4

What are the symptoms of alcohol withdrawal?

Answer 4

Tremor
Weakness
Nausea
Vomiting
Anxiety
Seizures
Confusion
Agitation
Death

Question 5

When does delirium tremens occur and what are its symptoms?

Answer 5

Can occur in alcohol withdrawal, usually 48-72 hours after stopping alcohol
Symptoms:
-Profound confusion and agitation
-Tremor
-Psychosis
-Sleeplessness
-Autonomic over-activity

Question 6

What are the potential causes of death in delirium tremens?

Answer 6

Cardiovascular collapse
Hyperthermia
Infection
Seizures 
Self-injury

Question 7

What mental health problems can alcohol cause?

Answer 7

Anxiety
Depression
Sleep disruption
Morbid Jealousy
Alcoholic hallucinosis
Deliberate self-injury
Suicidal thoughts/acts

Question 8

What is the triad of symptoms associated with Wernicke’s encephalopathy?

Answer 8

Confusion
Ataxia
Nystagmus

Question 9

What are the symptoms of Korsakoff’s psychosis?

Answer 9

Involves a prominent impairment of recent and remote memory

Question 10

What screening tools can be used to assess alcohol use?

Answer 10

CAGE
FAST
AUDIT

Question 11

What general measures can be given in alcohol use management?

Answer 11

Support for patient and family
Psychological help (e.g. CBT, group therapy)
Social work input (benefits, housing, child protection)
Skills training
Community Support (eg AA, ADA)
Inpatient or residential treatment
Medication

Question 12

What medications can be used in alcohol use management?

Answer 12

Prevention of Wernicke-Korsakoff syndrome (IV Thiamine)
Management of alcohol withdrawal (benzodiazepines)
Aversion/deterrent medication (disulfiram)
Anti-craving medication (acamprosate, naltrexone, nalmefene)

Question 13

What are the advised units for alcohol consumption?

Answer 13

It is advised that people do not regularly exceed >14 units per week, spread over at least three days

Question 14

How does alcohol related liver disease progress?

Answer 14

1. Normal liver
2. Fatty liver/steatosis
3. Steatohepatitis
4. Fibrosis
5. Liver cirrhosis

Question 15

How does steatosis occur?

Answer 15

Occurs due to the breakdown of alcohol into fatty acids, as well as the high calorie content of alcohol. Fat is first deposited around the central veins and then into the parenchyma. If the patient abstains from alcohol then the liver will return to normal

Question 16

What are the clinical indicators of chronic alcohol use?

Answer 16

Macrocytosis (enlarged red blood cells)
Elevated gamma GT
Low platelets
Raise ferritin 
Enlarged, smooth-edged liver on AUSS
History

Question 17

What is the pathology of alcoholic hepatitis?

Answer 17

Involves fatty change in the liver with infiltration of leucocytes and hepatic necrosis

Question 18

What are the potential complications of alcoholic hepatitis?

Answer 18

Hepatomegaly
Jaundice
Abdominal pain
Fever
Hepatic decompensation
Potential cirrhosis

Question 19

How is alcoholic hepatitis managed?

Answer 19

There is no real treatment for alcoholic hepatitis, but steroids, management of infection, nutrition and abstinence from alcohol all seem to be good management measures

Question 20

What processes are involved in liver fibrosis?

Answer 20

Chronic inflammation
Activation of Stellate cells
Collagen production

Question 21

What processes are involved in liver cirrhosis?

Answer 21

Localised fibrosis around veins
Collagen bridging between veins/tracts
Loss of lobule structure

Question 22

What are the possible complications of cirrhosis?

Answer 22

Variceal haemorrhage
Encephalopathy
Ascites