Alcohol

Question 1

What are the guidelines regarding weekly alcohol consumption?

Answer 1

• exceed no more than 14 units a week on a regular basis and spread your drinking over 3 or more days
• the more you drink, the more you are at risk of health problems

Question 2

What are symptoms and signs of alcohol intoxication?

Answer 2

• nausea and vomiting
• impaired attention and judgement
• unsteadiness
• flushing
• nystagmus
• mood instability
• disinhibition
• slurring
• stupor
• unconsciousness

Question 3

When would ‘harmful use of alcohol’ be diagnosed as opposed to acute intoxication?

Answer 3

• pattern of causing damage to physical or mental health

- alcohol use >1month or repeatedly over 12 months

Question 4

When would alcohol dependence be diagnosed?

Answer 4

3 or more of the following for >1month or repeatedly over 12 months:

• cravings/compulsions to take
• difficulty controlling use
• primacy
• increased tolerance
• physiological withdrawal on reduction/cessation
• persistence despite harmful consequences

Question 5

What are symptoms and signs of alcohol withdrawal?

Answer 5

• tremor
• weakness
• nausea
• vomiting
• anxiety
• seizures
• confusion
• agitation
• death
• delirium tremens

Question 6

What characterises delirium tremens?

Answer 6

• profound confusion
• tremor
• agitation
• hallucinations
• delusions
• sleeplessness
• autonomic overactivity

Question 7

What would be the cause of death in delirium tremens?

Answer 7

• cardiovascular collapse
• infection
• hyperthermia
• seizures
• self injury

Question 8

When will delirium tremens set in?

Answer 8

usually 48-72 hours after alcohol stopped

Question 9

What is wernicke’s encephalopathy?

Answer 9

• prolonged abuse of alcohol can lead to vitamin B deficiency
• this condition is a s a result of B deficiency

Question 10

What characterises Wernicke’s encephalopathy?

Answer 10

• confusion
• ataxia
• opthalmoplegia
• nystagmus

Question 11

How can Wernicke’s encephalopathy be treated?

Answer 11

symptoms completely reversible if treated with parenteral thiamine

Question 12

What is Korsakoff’s psychosis?

Answer 12

• chronic Wernicke’s encephalopathy leading to irreversible brain damage
• long term thiamine deficiency

Question 13

What are characteristics of Korsakoff’s syndrome?

Answer 13

problems learning new information, inability to remember recent events and long-term memory gaps. Memory problems may be strikingly severe while other thinking and social skills are relatively unaffected. For example, individuals may seem able to carry on a coherent conversation, but moments later be unable to recall that the conversation took place or to whom they spoke.

Those with Korsakoff syndrome may “confabulate,” or make up, information they can’t remember. They are not “lying” but may actually believe their invented explanations. Scientists don’t yet understand why Korsakoff syndrome may cause confabulation.

Question 14

What screening tools can be used to assess alcohol related health problems?

Answer 14

• CAGE
• AUDIT
• FAST
• PAT

Question 15

Describe CAGE.

Answer 15

(2 or more = likely alcohol problem)
Have you tried to Cut down?
Have you felt Annoyed by people criticising your drinking?
Have you felt Guilty about drinking?
Have you felt the need to have an Eye-opener

Question 16

What is a common medication used to manage alcohol withdrawal?

Answer 16

benzodiazepines e.g. chlordiazepoxide

Question 17

What medication can be used as a deterrent to taking alcohol?

Answer 17

medication that will make you feel uncomfortable when you take alcohol to try and put you off it e.g. disulfiram

Question 18

What are examples of medications that can be used for anti-craving?

Answer 18

-acamprosate
-naltrexone
-nalmefene
idea is that reduces endogenous opiate effect of taking alcohol which will make it less pleasurable to drink

Question 19

What can chronic alcohol excess do to the liver?

Answer 19

alcoholic fatty liver(reversible)–alcoholic hepatitis(reversible)—alcoholic cirrhosis(irreversible)

Question 20

What is the prognosis of alcoholic fatty liver?

Answer 20

• good if become abstinent (disappears within 6 weeks of abstinence)
• can go on to alcoholic hepatitis and alcoholic cirrhosis if keep drinking

Question 21

At what level of daily alcohol intake is alcoholic hepatitis a risk? What other signs indicate diagnosis of alcoholic hepatitis?

Answer 21

• alcohol intake>6 units per day
• drinking until previous 3 weeks
• jaundice with bilirubin>80
• no evidence of other liver disease or biliary obstruction

Question 22

What tool can be used to assess severity of alcoholic hepatitis?

Answer 22

Glasgow hepatitis score

looks at coagulation, age, urea etc

Question 23

What glasgow hepatitis score indicates poor prognosis in alcoholic hepatitis?

Answer 23

> 9

Question 24

What are possible causes of liver cirrhosis?

Answer 24

• alcoholic liver disease
• hepatitis B and C
• non alcoholic fatty liver disease
• haemochromatosis

Question 25

What is the main cause of high mortality liver cirrhosis?

Answer 25

alcohol

Question 26

What is meant by ‘decompensated liver disease’?

Answer 26

• liver not doing what it should
• gastrointestinal bleeding
• encephalopathy
• ascites are all signs

Question 27

What is the treatment of hepatocellular cancer?

Answer 27

• surgical resection
• liver transplant
• radiofrequency/microwave ablation
• transarterial embolisation
• chemotherapy

Question 28

What is he most common reason for liver transplantation in scotland?

Answer 28

alcohol related liver disease

Question 29

What are resistant complications of cirrhosis?

Answer 29

• jaundice
• ascites
• coagulopathy
• encephalopathy