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PBL > Unit 8: Alcohol, drugs and STIs > Flashcards

Unit 8: Alcohol, drugs and STIs Flashcards

1
Q

Why might a doctor request an ultrasound of the liver?

A

Jaundice
upper right abdominal pain
Elevated liver enzymes

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2
Q

What are the key things that a liver ultrasound can identify?

A

Gallstones
Cirrhosis
Growths and lesions
inflammation (hepatitis)

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3
Q

What three factors must be considered on a liver ultrasound?

A

Echogenicity
Surface
Echotexture

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4
Q

How does cirrohis appear on an ultrasound?

A

Increases texture
And nodular surface

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5
Q

How does fatty liver disease appear on an ultrasound?

A

Hyperechoic liver compared to the kidney

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6
Q

What substances are tested for in a liver function test?

A

ALT and AST
Alkaline phosphatase and y-glutamyltransferase
Bilirubin
Albumin

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7
Q

How and why do you expect levels of AST and ALT to change if the liver is damaged?

A

Liver enzymes inlvoved in protein metabolism
If the liver is damaged these substances will be released into the blood - hence level increases
Level AST are less reliable as can also be released from muscle damage

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8
Q

How and why do levels of alkaline phosphatase and y-glutamyltransferase change if the liver is damaged on a blood test?

A

Found in the bile duct of the liver.
Elevated when the bile duct or gall bladder is obstructed
GGT - indicative of fatty liver disease
Normally enzymes involed in protein metabolism

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9
Q

How and why do levels of bilirubin change on a blood test when the liver is damaged?

A

Increase
Bilirubin is a product of rbc breakdown - billirubin is converted into a soluble form by the liver, made into a componenet of bile, and is excreted
When the liver is damaged this process fails and billirubin accumulates in the blood.

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10
Q

How and why do levels of albumin change in a liver function test when the liver is damaged?

A

Decreases
Albumin is a protein produced by the liver, liver damage impairs metabolism

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11
Q

What are some of the observable characteristics of liver disease?

A

Jaundice - yellowing of the eyes, urine and stool
Males - decreased oestrogen breakdown, breast tissue growth, spider naevi and testicular atrophy
Encephalopathy - decreased absoprtion of vitamin B6 needed for neural function
Ascites - swollen abdomen, hepatic failure increases levels of NOx, hypotension, activates RAAS, accumulation of salt and water in the peritoneal cavity
palmar erythema - redness of hands

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12
Q

What does an abdominal exam indicate?

A

Upper right abdominal pain - most commonly gall bladder
Gall bladder acute, liver more chronic and dull present after a few weeks of pain
Seperate gut in for - epi, mid - gastri and hind - hypo
Unilateral structures, pain often radiates through to the back and is worse when bending forward

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13
Q

How is CAGE used to test alcohol dependency?

A

C - cut down
Annoyed - pestered by others to cut down
Guilty -
Eye opener - drinking in the morning or to calm nerves

Score of 2 or higher is clinically significant

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14
Q

How does the AUDIT test screen for alcohol dependency?

A

Up to 10 questions, scored out of fourty.
Key three questions: how much do you drink on a night out? how often do you drink? Do you binge drink over the recommended limit?
If yes to two of the above will answer following questions ont he effect of alcohol e.g guilt, injury, memory loss
Score below 7 is a low risk
Score below 14 is hazardous
Acore baove 14 indicates dependence

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15
Q

What is the progression of disease from the alcohols effect on the liver?

A

Steatosis - alcohol fatty liver disease
Hepatitis - inflammation of the liver
Cirrhosis - scarring of the liver

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16
Q

How is alcohol metabolised in the liver?

A

Ethanol is oxidised to acetaldehyde by alcohol dehydrogenase
Acetaldehyde denhydrogenase will oxidise acetaldehyde down into acetate.

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17
Q

How does alcohol metabolism in the liver lead to fatty liver disease?

A

Oxidation of alcohol - increases NADH and decreases NAD+ available
This impairs glycolysis and gluconeogenesis/beta oxidation (lactic acidosis and hypoglycaemia)
This can lead to abnormal lipid metabolism - TG synthesis and accumulation of fat within hepatocytes

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18
Q

How does alcohol lead to hepatitis?

A

Acetaldehyde - toxic substance - prolonged liver damage and necrosis
Damps trigger inflammation leading

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19
Q

How does liver damage lead to cirrhosis?

A

Damps trigger inflammation leading to fibrosis
Disregulates normal levels of liver regneration and repaiir causinf nodule formation

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20
Q

What are the symptoms of hepatitis?

A

Pain, jaundice, fatigue and fever

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21
Q

What are teh symptoms of cerrhosis?

A

Fatigue, weight loss, abdominal pain, jaundice and a swollen abdomen

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22
Q

What are the effects of alcohol on the CNS? (short term)

A

Inhibitory efffect - effects learned process and cognition before mechanical tasks
Activates GABA A receptors
INhibits Glutamates NDMA receptors
Activates seratonin and dopamine receptors
Inhibits monoamine oxidases
Decrease ADH
Anti-convuslive effects

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23
Q

What is wernickes encephalisitis? What are the long term changes of alcohol in the brain?

A

Alcohol decreases absorption of vitamin B6 and dmages the hippocampus
Leads to dementia like symptoms and permanent damage to the Papez circuit

24
Q

What are the different pathways in addiction?

A

Mesolimbic dopamine pathway
Mesocortical pathway
Hippocampus and amygdala

25
What is the mesolimbic dopamine pathway?
Ventral tegmental area dopmanic neurones cause dopamine release in the nucleus accumbens. Triggers endoprhin release Activates the globus pallidus - reinforces as habit
26
What is the mesocortical pathway for addiction?
Ventral tegmental area dopaminergic neurones increase levels of dopamine in the frontal cortex. Impulsivity - globus pallidus is no longer regulated Causes glutamates release in the midbrain - consolodiate alcohol as a pleasurable memory.
27
What is the cause and treatment for chlamydia?
Caused by chlamydia trachmatis More common in females Treated by antibiotcs typically - arithromycin May be congenital, oral, vaginal or anal sex
28
What is the test for clamydia?
NAAT test Female from vaginal swab Male from urine 7 to 10 days
29
What are the short term symptoms of chlamydia?
Discharge Burning when urinating Pain or swelling in testicicles Rectal pain and bleeding Pain with sex Irregular bleeding in women
30
What are some of the long term symptoms of chlamydia?
Infertility - scar tissue is fallopian tubes Ectopic pregnancy Pelvic inflammatory disease and pain (F) Decrease sperm motility (M)
31
What are the causes of syphylis?
Unprotected sex - come in contact with ulcers Blood borne transmission Congenitla BActeria: Traponema pallidum
32
What is the treatment for syphylis?
Benzathine penicillin G injections
33
What is the test for syphylis?
Physical exam - sores and collect fluid from sore Blood sample
34
What are the symptoms of syphylis?
Painless ulcers White or grey warts Rash on palms and soles Immediate flu like symptoms Can take 3 weeks for symptoms to show
35
What are the long-term symptoms of syphylis?
Cardiovascular problems Nerve pain Neurological - memory deficits and personality changes
36
What is the cause of HPV?
Vaginal or anal sex HPV is a DNA non-enveloped virus
37
What are the tests and treatment for HPV?
Test - none in men Females - may be detected by cervical cancer screening No current treatment May be vaccinated against in childhood
38
What are the symptoms of HPV?
Genital warts
39
What causes herpes?
Caused by HSV Oral, anal or vaginal sex - skin to skin
40
What are the tests are treatment for herpes?
Swab of blisters and ulcers Blood test No cure aciclovir to aid management
41
What are the symptoms of herpes?
Primary flu like infections Painful lymph nodes Tingling in genital areas Genital blisters or ulcers
42
What are the causes of gonorrhoea?
Neisseria Gonorrhoea Semen or vaginal fluid
43
What are the tests for gonorrhoea?
Light micrscope Gram negative diploccis in discharge
44
What is the treatment for gonorrhoea?
High dose cephlasporin
45
What are the symptoms of gonorrhoea?
Discharge Pain when urinating Pelvic and testicular infection Conjunctivitis Sepsis
46
What is the pharmacology of azithromycin?
Inhibits translocation by targeting the 23sRNA in the 50S Subunit of the ribosome, inhibiting translocation of the amnioacycl rTNA. This inhibits peptide chain elongation
47
What is the general working of a morning after pill?
More effective if taken before ovulation and closer to the time of sexual intercourse TYpically are high dose oesotrgen and high dose progesterone, that activates negative feedback to inhibit FSH and LH
48
What is the pharmacology of Levonelle?
Morning after pill Take within 3 days of unprotected sex Progesterone - suppresses gonadotropin release from the hypothalamus by binding to androgen and progesterone receptors To prevent follicle rupture Increases the thickness of cervical mucus Is a progestin
49
What is the pharmacology of Ellaone?
Take within 5 days of unprotected six Ulipristal acetate - stops prgesterone from working correctly by binding to some progesterone receptors, this prevents the maintaining of the uterus lining This inhibits implantation
50
What is compulsive drug use?
Consistent drug use despite knowing the negative consequences, impulsibe behaviour beyond the persons control as a biological need to continue is stronger than the psychological want to stop
51
What is alcohol dependence?
Signalling pathways and receptors are altered from normal physiological functioning. Often develop dependence from tolerance, require alochol dopmaine hit to reach basic level of functioning. Unable to control their use of alcohol.
52
What are the most common reasons why people start taking drugs?
Social Glorification Peer pressure and self medication
53
What are the characteristics of people affected by alcohol dependency?
Male - long term addicition Female - become addicited faster Genetics - acetylcholine receptors genes Personality wise - low conscientiousness, low agreeablenessm high neuroticisim and high openess to new experience Typically are young adilts - between 18 and 25yrs
54
What are the short term effects of alcohol on sexual behaviour?
Short term - increase confidence and decreased inhibitions Decreased functioning of the amygdala - less fear of consequences Decreased prefrontal lobe functioning - less ration behaviour
55
What are the long term effects of alcohol use on sexual behaviour?
Erectile dysfunction in men due to vasodilatory effects Decreased testosterone - leading to lower libido, infertility and genital atrophy Can interfere with sensation from genitalia, leads to premature ejaculation or no ejaculation
56
What is illicit drugs use?
Use of illegal or highly addicitive substances THe most common are opiods, cocaine, benzodiazipines, MDMA and canabis.
57
What are the biological effects of ACEs on brain functioning?
Grows the amygdala - increased fear response Shrinks the prefrontal cortex - decreases problem solving and emotional regulation, unable to regulate amygdala Shrinks the hippocampus - struggle to consolidate new memoriese, struggle to change triggersing stimuli, more false alarms.

PBL (23 decks)

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