What is the NICE recommended for pregnant women drinking?
Abstain 1st trimester and then no more than 2 units per week
What is hazardous drinking? What is the level in men and women?
Pattern of alcohol use which increases someone’s risk of harm
Men: 50+ units
Women: 35+ units
What male/female units are regarded as increasing risk drinking?
Men: 22-50
women: 15-35
How many grams of alcohol in 1 unit?
8g
How do you calculate units?
ABV (%) x litres
How many units of alcohol in 250ml of 14% wine?
250ml = 0.25L
0.25 x 14 = 3.5
Who metabolises alcohol faster: men or women? why?
Men - lower body fat percentage
Why has there been an increase in women drinkers?
- More socially acceptable
- More disposable income
- More drinks marketed at women
- More drinking places aimed at women customers
What are some social + psychological RFs for problem drinking?
- Lower socioeconomic status
- Drinking within the family
- Childhood problem behaviour relating to impulse control
- Early use of alcohol nicotine and drugs
- Poor coping responses to life events
- Depression as a cause not a result of problem drinking
What are the most common causes of death due to alcohol?
- Accidents and violence
- Malignancies
- Cerebrovascular disease
- Coronary artery disease
Apart from cirrhosis, what health problems does alcohol cause?
- Malignancy
- Mental health
- GI (bleeding/PUD)
- Coagulopathy
- Birth defect
- Neurological: Wernicke’s-Korsakoff; dementia; peripheral neuropathy
- E.D.
- T2DM
…etc
Is alcoholic fatty liver disease reversible?
Yes
What conditions are involved in alcoholic liver disease?
Steatosis (fatty liver)
Alcoholic hepatitis
cirrhosis
What can liver cirrhosis lead to?
Hepatocellular carcinoma
What symptoms are present in fat liver?
Asymptomatic (maybe malaise or nausea)
What symptoms develop in alcoholic hepatitis?
Anorexia, N, abdo pain, weight loss, more susceptible to infection
severe: ascites, bleeding, encephalopathy
How might moderate alcohol intake protect against ischaemic heart disease?
Raised HDL lipids
How can alcohol cause heart disease?
Hyperlipidaemia, HTN, Precipitate arrhythmias (notibly AF)
What arrhythmia does alcohol typically cause?
AF
What cancers are associated with alcohol?
Head + neck: mouth, larynx, pharynx, oesophagus
liver, stomach, colon, rectum, pancreas
Breast
how can alcohol affect pregnancy?
^ miscarriage rate
IUGR/low birth weight
spectrum of problems for fetus (most extreme being FAS)
Give some symptoms of FAS
Small/underqeight babies lacking muscle tone
Learning disability, behaviour problems (ADHD/autism), speech problems
Facies: smooth filtrum, epicanthal folds, thin upper lip, microcephaly, short palpebral fissure, low nasal bridge, flat mid face, micrognathia
CHD, + renal/ocular abnormalities
What are some forensic issues with alcohol?
Crime (including domestic violence)
What general supportive/care measures can a GP do for someone w/ alcohol problem?
- Vitamin Supplementation
- Assess IHD risk
- Consider osteoporosis risk
Give 2 screening questionnaires for alcohol
AUDIT or CAGE
NOT BLOOD TESTS
What can’t be used to screen for alcohol problems?
bloods (e.g. GGT) –> use to assess severity / progress
What AUDIT score suggests hazardous drinking?
score of 8
What AUDIT score suggests alcohol dependence?
Men: 15
Women: 13
How do you prevent relapse in alcohol dependence?
Disulfiram (Antabuse)
Naltrexone
Acamprosate (GABA blocker)
NONE ARE PARTICULARLY EFFECTIVE
What does antabuse (disulfarim) do?
Acute reaction to ingestion of ethanol (makes person very ill)
Does this by inhibiting acetaldehyde dehydrogenase (which breakdown acetaldehyde dehydrogenase into acetic acid) –> acetaldehyde builds up
What alcohol metabolite causes a hangover?
acetaldehyde
What symptoms are required for a diagnosis of alcohol dependence syndrome?
3 of the following (in a 12th period):
- tolerance-increasing amount of alcohol to achieve the same effect
- characteristic physiological withdrawal
- difficulty controlling onset, amount and termination of use
- neglect of social and other areas of life
- spending more time obtaining and using alcohol
- continued use despite negative physical and psychological effects
What vitamin is thiamine?
B1
What causes wernicke’s encephalopathy?
Due to vit B1 deficiency (thiamine)
What is the triad of symptoms seen in wernicke’s?
Acute mental confusion
Ataxia
Nystagmus/Ophthalmoplegia
How can wernicke’s encephalopathy be treated?
IV/IM/Oral thiamine (e.g. pabrinex)
Is wernicke’s encephalopthy reversible? What happens if it is untreated?
Yes (Korsakoff’s isn’t)
the person develops korsakoff syndrome
What is korsakoff syndrome? What 2 things characterises it?
amnesic disorder due to b1 malnutrition
anterograde amnesia and confabulation
What are the symptoms of Korsakoff syndrome?
Symptoms of memory loss especially short term memory
Confabulation
Loss loss spontaneity, initiative and confabulation
Diagnosis by CT scanning
What is seen on CT scan in korsakoff syndrome?
CT scan - hypoplasia of maxillary bodies?
What is affected in the brain Wernicke’s korsakoff syndrome?
Mammillary bodies
What is delirium tremens?
Withdrawal state
A short lived (3-5 days) toxic confusional state which usually occurs as as a result of reduced alcohol intact in alcohol dependence individuals with a long history of use.
Give some symptoms of delirium trimmers
Clouding of conciousness/confusion/seizures
Hallucinations in any sensory modality (e.g. lilliputian visual hallucinations)
Marked tremor
What is the treatment for delirium tremens?
Supportive (fluids)
BDZs to prevent seizures
What is the triad of delirium tremens?
Acute confusional state
Tremors
hallucinations/delusions