Case 3 - alcohol use - clinical perspective

Question 1

how many deaths a year worldwide

Answer 1

3 million

Question 2

it is the ….. leading cause of death

Answer 2

7th

Question 3

when is the peak incidence

Answer 3

35-54

Question 4

what percentage receive treatment in the UK

Answer 4

only 18%

Question 5

what is the prevalence of alcohol dependence in the uk

Answer 5

1.3% prevalence

Question 6

alcohol use disorder is categoried by which model

Answer 6

DSM-5

Question 7

alcohol dependence is categorised by

Answer 7

ICD-10 and DSM-IV

Question 8

what is dipsomania

Answer 8

alcoholism, specifically in a form characterized by intermittent bouts of craving for alcohol

Question 9

what is potomania

Answer 9

It is described as the excessive intake of alcohol, particularly beer, together with poor dietary solute intake that leads to fatigue, dizziness, and muscular weakness.

Question 10

what is potomania a unique syndrome of

Answer 10

hyponatremia

Question 11

diagnosis criteria using ICD-11 for alcohol dependence

Answer 11

disorder of regulation of alcohol use
Repeated or continuous use of alcohol
Strong internal drive to use alcohol
Present for 12 months or 1 month if continuous

internal drive, compulsion, desire, urge or craving to use alcohol
Impaired control
Prioritisation of alcohol over other activities
Persistent use despite harms

Question 12

what are two examples of neuroadaption in alcohol dependence

Answer 12

tolerance

withdrawal of symptoms and use of alcohol to alleviate withdrawal

Question 13

what is the CAGE questionnaire

Answer 13

C: have you ever felt that you needed to cut down on your drinking

A: have people annoyed you by criticising your drinking

G: have you ever felt guilty about drinking

E: have you ever felt that you need a drink first thing I the morning to steady your nerves or get rid of a hangover

Question 14

what is the gold standard screening tool for alcohol

Answer 14

AUDIT screening tool: FAST version

Question 15

what is FAST

Answer 15

it is an alcohol assessment harm tool. it consists of a subset of questions from the full alcohol use disorders, identification test AUDIT

Question 16

what was FAST developed for

Answer 16

developed for use in emergency departments, but it can be used in a variety of settings

Question 17

what is the first question of the FAST questionnaire

Answer 17

how often have you had 6 or more units if female and 8 or more if male in a single occasion in the last year?

Question 18

what happens if the answer is monthly or weekly

Answer 18

if monthly, answer the following questions, if weekly stop here

Question 19

what are the UK guidelines for safe drinking

Answer 19

14 units per weeks
spread use over three days if drinking 14 units a week

Question 20

what does one unit of alcohol equal

Answer 20

10ml or 8g of pure alcohol

Question 21

what is binge drinking for men

Answer 21

over eight units

Question 22

what is binge drinking for women

Answer 22

over six units

Question 23

what is frequent binge drinking between age 18-25 associated with

Answer 23

with 2-3 times increased risk of alcohol dependence between the ages of 25-45

Question 24

how many calories are in a gram of pure alcohol

Answer 24

7.1

Question 25

what are the effects of alcohol on the oesophagus

Answer 25

carcinoma of oesophagus, especially squamous carcinoma
Oesophageal varices, associated with chronic liver disease - watch out for Hb drops, raised urea, coffee ground vomit

Question 26

what are the effects of alcohol on the stomach

Answer 26

acute gastritis
Acute ulceration
Chronic peptic ulceration
Portal gastropathy

Question 27

what is the indirect effect of alcohol related liver disease

Answer 27

indirect metabolite effect e.g acetaldehyde

Question 28

what is there activation of in alcohol related liver disease

Answer 28

activation of free radicals

Question 29

what systems are induced in alcohol related liver disease

Answer 29

induction of enzyme systems especially cytochrome p450

Question 30

what is the usual vitamin deficient in alcohol related liver disease

Answer 30

B group

Question 31

what are the symptoms of acute pancreatitis

Answer 31

severe abdominal pain
Radiating to the back
Nausea and vomiting

Question 32

what is there elevation of in acute pancreatitis

Answer 32

serum amylase

Question 33

what are symptoms of chronic pancreatiits

Answer 33

intermittent severe upper abdominal and back pain
Weight loss

Question 34

what is exocrine tissue replaced by in chronic pancreatitis

Answer 34

fibrosis

Question 35

what does this lea to

Answer 35

pancreatic malabsoption - steatorrhoea and reduced vitamins

Question 36

what vitamins are reduced

Answer 36

A,D,E,K

Question 37

what percentage of heavy drinkers go on to progress to alcoholic hepatitis or cirrhosis

Answer 37

10-20%

Question 38

what does obesity do to the risk of alcoholic liver disease

Answer 38

doubles the risk

Question 39

are each of these reversible or irreversible symptoms of alcoholic liver disease:

acute fatty change
hepatic fibrosis
cirrhosis
hepatic decompression
acute alcoholic hepatitis

Answer 39

acute fatty change - reversible
Hepatic fibrosis - reversible
Cirrhosis - irreversible
Hepatic decompression - fatal
Acute alcoholic hepatitis - reversible

Question 40

what are the effects of alcohol on the cardiac system

Answer 40

atrial fibrillation
Myocardial infarction
Congestive heart failure
Cardiomyopathy

Question 41

what is Delirium Tremens

Answer 41

delirium with hallucinations and autonomic disturbances in alcohol withdrawal

Question 42

what is Wernicke’s encephalopathy

Answer 42

acute - delirium, ataxia and ophthalmoplegia - glutamatergic overdrive

Question 43

what is Korsakoff’s psychosis

Answer 43

chronic - triad of short term memory loss, confabulation and ataxia

Question 44

what are both these conditions secondary to

Answer 44

to effects of alcohol and B1(thiamine) deficiency

Question 45

what kind of polyneuropathy in particular is seen in alcohol dependence

Answer 45

stocking fashion

Question 46

what is polyneuropathy usually secondary to

Answer 46

Secondary to thiamine and other b vitamin deficiency e.g B12 (cobalamin)

Question 47

when are seizures present

Answer 47

in early withdrawal

Question 48

when are DT’s present

Answer 48

later on

Question 49

what is altered brain function attributed to

Answer 49

imbalance of excitatory and inhibition neurotransmission

Question 50

what does decrease GABAa receptor function lead to

Answer 50

increased seizure susceptibility, increased anxiety and altered sensitivity to alcohol cues

Question 51

what does increased NMDA receptor function lead to

Answer 51

increased seizure susceptibility, increased neurotoxicity and altered senstivity to alcohol cues

Question 52

what does increased voltage operated Ca2+ channel function lead to

Answer 52

increased seizure susceptibility, increased neurotoxicity

Question 53

what do you give if there is a decrease in GABAa function

Answer 53

you give benzodiazepines

Question 54

what do you give if there is an increase in NMDA function

Answer 54

thiamine or pabrinex

Question 55

what do you give if there is an increase in Ca2+ channel activity

Answer 55

you give acamprosate

Question 56

where does myopathy typically affect

Answer 56

proximal muscles in the pelvic girdle

Question 57

what is the major blood disorder usually found in alcohol abuse

Answer 57

thrombocytopenia and bleeding;
usually present with low platelets

Question 58

what is the relationship between alcohol and bone marrow

Answer 58

alcohol is toxic to bone marrow, leads to reduced normal cell levels

Question 59

what does the effect on the liver lead to

Answer 59

folate deficiency and other effects on RBCs

Question 60

what can all of this leaf to

Answer 60

pancytopenia

Question 61

list step by step, alcohol metabolism

Answer 61

ethanol is metabolised by alcohol dehydrogenase to acetaldehyde

then acetaldehyde is metabolised by aldehyde dehydrogenase to acetate

Question 62

why do we prescribe disulfiram

Answer 62

it stops the action of aldehyde dehydrogenase from metabolising acetaldehyde into acetate

Question 63

what should one do to reduce harm reduction in alcohol dependence

Answer 63

drink diary
Look at trigger points - consider changes to behaviour
Swap to lower strength alcohol
Low strength wine is available
if dependent people present and cannot under an inpatient or community detox then they should continue drinking - aim to drink at a level that prevents withdrawal symptoms
Unsupervised detox has a mortality of >10%
refer/signpost to drug and alcohol services

Question 64

what is the RADAR pathway in greater manchester

Answer 64

rapid access detox for alcohol dependent people requesting a detox in any A&E in manchester

Question 65

how long is the medically supervised detox in the RADAR pathway

Answer 65

5-7 days

Question 66

list the safe alcohol advice

Answer 66

alway have at least 4 consecutive days alcohol free
Try to avoid/minimise heavy sessions back to back
Try to avoid/minimise long drinking sessions
Eat a heavy meal before potential session at least 1-2 hours before - most alcohol is absorbed through the small intestine
Stay well hydrated and have more food early in the night when out

Substitute in non-alcoholic or lower alcohol options
Memory loss is a bad sign - avoid
Sometimes some people shouldn’t drink
Think about content and where you are at mentally and physically
Self care