Name three signs of chronic alcoholism you may see upon general examination of a patient.
Palmar erythema
Dupuytren’s contracture
Caput medusae
Acutely intoxicated patients are prone to falls - what brain injury can this cause?
Subdural haematomas - bleeding in the subdural space
What is Vitamin B1 also known as?
Thiamine
Give two other names for Thiamine deficiency.
Beriberi
Wernicke-Korsakoff syndrome
What are the three common symptoms of Wernicke-Korsakoff syndrome?
Ataxia (unsteadiness)
Abnormal eye movements
Impaired consciousness / memory loss
What is the name given to behaviour in which patients make up stories to disguise their memory loss?
Confabulation
Thiamine deficiency caused by alcoholism can also cause peripheral neuropathy - why?
What signs of peripheral neuropathy may patients present with?
Thiamine is responsible for maintaining peripheral nerves
Pain
Wrist drop
Foot drop
In the rare cases that the vagus nerve is affected by thiamine deficiency, what may patients present with?
Arrythmias
Congestive heart failure
Alcohol is a smooth muscle relaxant - what are three physiological consequences of this?
Opening of gastroesophageal sphincter
Snoring
Suppression of cough and gag reflexes
Relaxation of smooth muscle combined with loss of consciousness may lead to what respiratory disease in acutely intoxicated patients?
Aspiration pneumonia
Material is usually aspirated through the (left / right) main bronchus.
right main bronchus
Aspiration of foreign material into the lungs leads to ___ ___ and ___.
acute inflammation (pneumonitis)
infection
What are the most common sites for aspiration pneumonia?
Right middle lobe
Right lower lobe
depends on patient position at the time
Which inflammatory cells will be seen under the microscope of an aspiration pneumonia biopsy?
Neutrophils
Alcohol reduces the force of cardiac contraction - it is a ___ ___ agent.
negative inotropic agent
What happens to compensate for the negative inotropic effect of alcohol?
Heart rate increases - tachycardia
Common sensation the morning after binge drinking
What heart disease is associated with chronic alcoholism?
Dilated cardiomyopathy
Dilated cardiomyopathy presents as a big, heavy heart with ___ atrial/ventricular thickness.
normal
Dilated cardiac muscle is a bit crap at contracting - what does this put patients at risk of?
Arrythmias
Heart failure
What is the thiamine deficiency disease associated with cardiac arrythmias and heart failure in chronic alcoholics?
Wet beri beri
What is the initial liver disease seen in patients after one or two days of heavy drinking?
Alcoholic fatty liver disease
or steatosis
The accumulation of intracellular fat seen in AFLD is (reversible / irreversible).
reversible
Give four reasons for the accumulation of intracellular fat seen in AFLD.
1. More fatty acids delivered to liver
2. Alcohol converts NAD > NADH, stimulating lipid synthesis
3. Fatty acid oxidation is reduced
4. Reduced fat export by tubulins
What is the technical name for the accumulation of fat in hepatocytes?
Steatosis
What disease will be seen in a patient’s liver after 3-4 weeks of heavy drinking?
Alcoholic steatohepatitis
i.e fat accumulation AND inflammation
In alcoholic steatohepatitis, the direct toxicity of alcohol triggers ___ ___.
acute inflammation
What are three symptoms of alcoholic steatohepatitis?
Fever
Jaundice
Tenderness
Acute inflammatory cells
Ballooning
Mallory bodies
are all seen under the microscope in alcoholic steatohepatitis. What are they?
Lymphocytes
Fat inclusions in hepatocytes
Damaged intermediate filaments - stain dark pink
What occurs in the liver after many years of heavy drinking?
Cirrhosis
Cirrhosis is (reversible / permanent) liver damage.
permanent
Which cells deposit scar tissue around hepatocytes in a cirrhotic liver?
Ito cells
Which protein makes up the scar tissue deposited by ___ cells in a cirrhotic liver?
Collagen
Ito cells
Where specifically in the liver is collagen deposited during cirrhosis?
What is left behind afterwards?
Space of Disse
Islands of functioning hepatocytes surrounded by bands of scar tissue
Why do the “islands” of functioning hepatocytes work poorly in cirrhosis?
Reduced capacity to receive blood and metabolise the chemicals in it
Toxic waste builds up
Blood flow through cirrhotic liver is (good / poor).
poor
Where is blood redirected if the liver is cirrhotic?
Oesophageal veins
Splenic vein
Anorectal veins
Superficial veins
What are some signs of portal hypertension?
Oesophageal varices
Splenomegaly
Rectal varices
Caput medusae and spider naevi
Alcohol suppresses gluconeogenesis. What disease does this cause, which can be particularly dangerous in diabetics?
Hypoglycaemia
Alcohol ___ the gastric mucosa.
irritates
What happens to the rate of gastric emptying when the stomach is exposed to high concentrations of alcohol?
Rate of gastric emptying decreases
Why does the rate of gastric emptying decrease when the stomach is exposed to high concentrations of alcohol?
To reduce the rate of alcohol absorption by the small bowel
What name is given to the condition in which stress associated with vomiting causes a mucosal tear in the epithelium of the GO junction?
Mallory-Weiss tear
What is Boerhaave syndrome?
A full-thickness tear in the oesophageal wall
Explain the development of Barrett’s oesophagus in a chronic alcoholic.
- Alcohol relaxes smooth muscle (i.e lower oesophageal sphincter)
- Reflux of acidic liquid (sensation of heartburn)
- Damage to squamous epithelium
- Repeated insults
- Metaplasia: stratified squamous > columnar
Patients with Barrett’s oesophagus have increased chances of developing which type of oesophageal cancer?
Adenocarcinoma
Oesophageal varices are caused by portal hypertension secondary to which liver disease?
Cirrhosis
What is a varix?
Abnormally dilated vein
Oesophageal varices are prone to ___ causing massive haematemesis.
rupture
What are the common causes of acute pancreatitis?
GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion stings
Hyperlipidaemia
ERCP
Drugs
In pancreatitis, enzymes like lipase prematurely activate and digest cells in the pancreas - what is this process called?
Fat necrosis
What is intestinal epithelium?
Columnar epithelium with goblet cells
In pancreatitis, enzymes come into contact with fat and turn it into “soap”. What is this process called?
Saponification
What is the difference between Wernicke’s syndrome and Korsakoff’s syndrome?
Wernicke - Walking - ataxia, abnormal eye movements
Korsakoff - memory loss, confabulation
