2: Medical consequences of alcohol excess

Question 1

What is the weekly recommended limit of alcohol intake for men and women?

Answer 1

14 units

Question 2

Alcohol intake should be spread evenly over ___ days or more.

Answer 2

three

Question 3

Should pregnant women drink alcohol?

Answer 3

No

obviously

Question 4

Patients often (overestimate / underestimate) how much they drink.

Answer 4

underestimate

Question 5

Which lifestyle factor is mostly responsible for the increase in chronic liver disease mortality in Scotland?

Answer 5

Alcohol

Question 6

Young people tend to suffer the ___ consequences of alcohol excess.

Older people tend to suffer the ___ consequences of alcohol excess.

(chronic / acute)

Answer 6

acute

chronic

Question 7

Alcohol intake is also related to ___ disease.

Answer 7

cardiovascular

e.g MI

Question 8

As of 2003, what percentage of deaths in Scotland were caused by alcohol?

Answer 8

5%

Question 9

What is a liver disease associated with sustained excessive alcohol intake?

Answer 9

Alcoholic fatty liver disease

Question 10

What are some long-term complications of alcoholic fatty liver disease?

Answer 10

Cirrhosis

Hepatocellular carcinoma

Question 11

Excessive alcohol consumption causes ___ and ___ effects.

Answer 11

acute , chronic

Question 12

What are some acute CNS effects of alcohol excess?

Answer 12

Poor decision making:

Accidents

Violence

Question 13

What are some acute GI effects of alcohol excess?

Answer 13

Oesophagitis

Gastritis +/- gastric ulcers

Acute pancreatitis

Question 14

What are some acute respiratory effects of alcohol excess?

Answer 14

Aspiration

Respiratory depression

Question 15

What are some chronic cardiovascular outcomes of alcohol excess?

Answer 15

Hypertension

Cardiomyopathy

MI

Stroke

Question 16

What are some chronic GI outcomes of alcohol excess?

Answer 16

Liver disease (ALCOHOLIC FATTY LIVER DISEASE!!!)

Stomach disease

Pancreatic disease

Question 17

What is the presentation of Wernicke-Korsakoff’s syndrome?

Why does it occur?

Answer 17

Encephalopathy, lots of nervous/neuro problems

Vitamin B₁ (thiamine) deficiency as a result of chronic alcoholism

Question 18

Excessive alcohol use chronically causes (hypertrophy / atrophy) of the brain.

Answer 18

atrophy

Question 19

Underage drinking has effects on the development of the brain - how do these manifest?

Answer 19

Poor memory

Increased activity re: reward, desire, gratification

Question 20

What is foetal alcohol syndrome?

Answer 20

Pregnant women who drink cause damage to their foetus

Question 21

What is the presentation of foetal alcohol syndrome?

Answer 21

Impaired growth

Mental retardation

Learning disabilities

Behavioural problems

Question 22

Which enzymes play a role in alcohol metabolism?

Answer 22

Alcohol dehydrogenase

Aldehyde dehydrogenase

Question 23

Ketone bodies from alcohol are ___ and 80% of them are broken down to carbon dioxide and water by enzymes.

Answer 23

toxic

Question 24

Alcohol excess causes inflammation and fibrosis in the liver. What are the proper names for these two states?

Answer 24

Hepatitis

Cirrhosis

Question 25

What is the technical name for the process in which a liver is infiltrated by fat? What is the technical name for an inflamed fatty liver?

Answer 25

**Steatosis** **Steatohepatitis**

Question 26

Are **steatosis** and **steatohepatitis** reversible?

Answer 26

**Yes** if the patient stops drinking

Question 27

Is **cirrhosis** reversible?

Answer 27

**No** Fibrosis is established and does not resolve. Prevention of deterioration achieved by stopping drinking but the damage is done

Question 28

Any patient with cirrhosis has an increased risk of developing which cancer?

Answer 28

**Hepatocellular carcinoma**

Question 29

What are the diseases found on the spectrum of alcoholic liver disease?

Answer 29

**Alcoholic fatty liver disease** (steatosis) **Alcoholic hepatitis** (steatohepatitis) **Cirrhosis**

Question 30

What are some symptoms of alcoholic liver disease?

Answer 30

**Malaise** **Nausea** **Fever** **Jaundice**

Question 31

What are some signs of alcoholic liver disease?

Answer 31

**Hepatomegaly** **Jaundice** **Sepsis** **Abdominal distension** **Encephalopathy** **Renal dysfunction** **Long INR**

Question 32

What are some signs of ALD that you would see on examination?

Answer 32

**Spider naevi** **Encephalopathy** Signs of portal hypertension - **varices, caput medusae** **Splenomegaly**

Question 33

What is **thrombocytopenia**?

Answer 33

**Reduced number of thrombocytes** (platelets) **in the blood** ## Footnote **Contributes to increased clotting time seen in liver disease**

Question 34

Which grading system can be used to decide on a cirrhosis patient's prognosis?

Answer 34

**Childs system**

Question 35

In **alcoholic liver disease,** which liver enzyme is raised?

Answer 35

**AST**

Question 36

In **alcoholic liver disease, \_\_\_** is higher than **\_\_\_.** (ALT, AST, ALP, GGT)

Answer 36

**AST \> ALT** remember that when you drink alcohol you get w**AST**ed

Question 37

How are alcoholic hepatitis patients treated?

Answer 37

**Supportive treatment** (fluids, blood transfusion)

Question 38

Which drug improves alcoholic hepatitis mortality **in the short term**?

Answer 38

**Steroids** e.g prednisolone