the clinicians perspective

Question 1

when can withdrawal start from

Answer 1

6-8 hours after last drink

Question 2

mild symptoms of withdrawal

Answer 2

12-36 hours from last drink

fine tremoue, sweating, anxiety, hyperactivity, increase HR, increased BP, fever, anorexia, nausea, retching

Question 3

moderate symptoms of withdrawal

Answer 3

12hours - 5 days

coarse tremour, shaking, agitation, confusion, disorientation, paranoia, seizures (esp after 24-48), hallucinations

Question 4

severe symptoms of withdrawal

Answer 4

12 hours - 7 + days 
more severe and prolonged 
risk of DTs around 48 hours 
severe agitation 
anxiety, confusion, delusions, hallucinations (tactile visual - crawling beasties)
circulatory collapse and death

Question 5

when do alcoholics usually have seizures

Answer 5

morning

Question 6

peripheral neuropahty symptoms

Answer 6

sensorimotor axonal polmeuropathy ‘glove and stocking’

burning pain + weakness

Question 7

peripheral neuropahty definiton

Answer 7

direct damage to peripheral nerves from alcohol

nutritional deficiencies e.g. thiamine

Question 8

compression neuropathy definitoin

Answer 8

temporary damage to myelin sheath

Question 9

compression neuropathy also known as

Answer 9

Saturday night palsy

Question 10

commonest compression neuropathy

Answer 10

radial nerve compression at humeral head

Question 11

what is myopathy

Answer 11

• acute, after binges - myalgia, proximal weakness, swollen tender muscles, raised CK - recovered weeks to months
• chronic - develops over weeks to months, painless, proximal weakness and atrophy, normal CK, low K, PO4 - incomplete recovery takes months

Question 12

what is wernickes encephalopathy

Answer 12

thiamine deficiency and cytotoxic oedema in maxillary bodies

Question 13

what does WE cause

Answer 13

ocular dysfunction (nystagus)
ataxic gait
acute confusion

Question 14

how to treat WE

Answer 14

thiamine replacement

Question 15

what is Korsakoff syndrome

Answer 15

cerebral atrophy resulting from WE

Question 16

symptoms of KS

Answer 16

• profound anterograde amnesia (unable to retain new information)
• variable retrograde amnesia = episodic memory
• conflabulation - replaces memory with info able to retain at that time - believes it to be true
• lacks insight

Question 17

how many people get dementia

Answer 17

50-70%

Question 18

which shape is the graph between alcohol and cardiovascular mortality

Answer 18

J shaped

Question 19

how does alcohol cause cardiomyopathy

Answer 19

8-9 units a day for 5+ years
alcohol impair ventricular function (calcium homeostasis, mitochondrial effects, signal transduction)
- prolonged exposure leads to chronic inflammation / fibrosis of myofibrils

Question 20

acute arrhythmia caused by alcohol

Answer 20

SVT holiday heart

resolves within 24 hours

Question 21

chronic arrhythmias caused by alcohol

Answer 21

electrolyte imbalance - long QT

dilated cardiomyopathy - atrial and ventricular arrhythmias

Question 22

how much alcohol = rapid rise in rate of cirrhosis

Answer 22

> 30 units / week

Question 23

pathway of alcohol leading to cirrhosis

Answer 23

regular heavy drinking 
fat accumulation in hepatocytes
inflammation
fibrosis 
cirrhosis

Question 24

what percent of heavy drinkers get cirrhosis

Answer 24

10-20%

Question 25

what is alcohol related steatosis

Answer 25

common presentation to OPC with abnormal LFTs

hepatocytes swell with triglycerides

Question 26

is steatosis reversible

Answer 26

yes

Question 27

what is alcohol related hepatitis

Answer 27

parenchymal inflammation and hepatocyte damage