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Psychiatry > Alcohol and the Liver > Flashcards

Alcohol and the Liver Flashcards

(50 cards)

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1
Q

What are the functions of the liver

A 
Process alcohol 
Carbohydrate metabolism 
Fat metabolism 
Protein metabolism
Storage
Synthesis 
Bile production 
Kupffer cells - rubbish collector 
Conjugate bilirbuin
Metabolise drugs
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2
Q

How does liver process alcohol

A

Alcohol broken to acetyladehydrate - using ADH / ALDH
Further to Acetate
Further to FA, CO2, H20
Overload leads to build up of toxic chemicals

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3
Q

What does liver synthesise

A

Albumin
Clotting factor - fibrinogen
Thrombopoeitin - production of platelet

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4
Q

What does liver store

A

Glucose
Iron - ferritin (transferrin + ferropoeitin)
Copper
Vitamins

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5
Q

Recommended drinking

A

<14 units per week
Over 3 days
>100 = serious liver

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6
Q

Why are only some heavy drinkers affected by liver disease

A 
Genetics - polymorphism of enzyme 
Nutritional deficiency / poor diet 
Co-exisitng virus
Other drug
Female
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7
Q

What causes liver cirrhosis

A 
Alcohol 
NAFLD 
Hep C
Autoimmune
Other
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8
Q

What gives an indication of stage of liver disease

A

Fibroscan

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9
Q

How does liver disease progress

A 
Normal
Fatty liver (steatosis) 
Steatohepatitis
Fibroisis
Liver cirrhosis
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10
Q

What causes fatty

A

FA’s deposited
Progress to inflammation
Reversible

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11
Q

What is fibrosis

A

Chronic inflamamtory by Stellate and Kuppfer cells

Scarring and collagen production

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12
Q

What is cirrhosis and what is seen on USS

A

Fibrosis
Loss of structure
Collagen between vein
Scallop edge on USS

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13
Q

What are complications of liver disease

A

Variceal haemorrhage
Encephalopathy as ammonia builds up
Ascites
HCC

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14
Q

What is alcoholic hepatitis

A

Fatty change
Leucocyte infiltration
Hepatic necrosis

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15
Q

How does alcohol hepatitis present

A 
HSM
Jaundice
Abdominal pain
Fever 
Can present decompensated 
May or may not have cirrhosis
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16
Q

How do you measure severity

A

Glasgow Alcohol Hepatitis Score
Age
Inflammation markers
Liver function

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17
Q

How do you treat alcohol hepatitis

A

Abstinence
Steroid if Maddrey >32
Rx infection
Nutrition

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18
Q

What are complications of alcohol hepatitis

A

Renal

Coagulopathy

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19
Q

What screening tools can be used for harmful alcohol use

A

CAGE - cutting down, annoyed, guilt, eye opener

FAST

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20
Q

What should you get in history

A 
What
How much
How often
Dependence
Complications
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21
Q

What medication can be offered if drinking too much

Study These Flashcards
A

Thiamine (B1) - Paprinex if diet deficient
Deterrant
Anti-craving
Withdrawal Rx

22
Q

What is 1st line in withdrawal and what one

Study These Flashcards
A

Benzodiazepine

  • Chlordiazepoxide = quick and long acting = 1st line (Librium)
  • Diazepam 2nd line
23
Q

What else can you give in withdrawal

Study These Flashcards
A

Carbamazepine

Haloperidol

24
Q

What is deterrent medication

Study These Flashcards
A

Disulifram
Makes you feel sick as decrease metabolism by inhibiting enzyme the breaks down
Take every day
CI IHD or psychosis

25
What is anti-craving medication
Acramrosate = 1st line Naltrexone Buclofen - muscle relaxant
26
What is the treatment for alcohol abuse
Practical advice Education Harm reduction Social work input - housing / child protection / benefit
27
What is psychological treatment
``` CBT Motivational interview 12 step programme AA Skills training ```
28
What are other physical complications
``` Hallucination Dementia Infection High BP Lose of muscle mass Impotence Infertility Poor DM Pancreatitis Cancer ```
29
What are mental complications
``` Depression Anxiety Sleep / insomnia Psychosis Morbid jealously - Orthello Self injury / suicide ```
30
What other problems
``` Aggression Marital Financial Occupation Isolation Neglect Poor parenitng Legal ```
31
What are signs of chronic alcohol use
``` Elevated gamma GT Macrocytosis Low platelet Elevated ferritin Abnormal LFT Low albumin Abnormal clotting ```
32
What are signs of alcohol withdrawal
``` Tremor Tachycardia Sweat N+V Anxiety Weakness Confusion Agitation Seizure - may present with this ```
33
When does withdrawal happen
6-12 hours | Seizures at 36 hour
34
What causes withdrawal
Opposite neurochemistry to alcohol (same as benzodiazepine) Decreased GABA Increased NMDA
35
What should you do if someone in withdrawal and what is used for assessment
Admit till stable esp if seizure / DT CLWA - withdrawal assessment Severity and decide treatment
36
When does delirium tremens occur and why
72 hours Alcohol stimulates GABA and inhibits NMDA When alcohol removed GABA under functions and NMDA over functions = increased adrenergic
37
What are the symptoms of delirium tremens
``` Profound confusion Autonomic overactivity Hallucination- tactile / visual Delusion Tremor Agitation Fever / tachy / HTN Ataxia Arrhythmia ```
38
What are the risks of DT
``` Seizure Self injury CVS collapse Infection Hyperthermia ```
39
How do you Rx
Benzo 1st line (chlordiazepoxide or lorazepam) Carbamazepine 2nd line Haloperidol
40
What does chronic alcohol lead too
B1 deficiency as decreased nutrition and increased requirement
41
What can B1 defiincecy cause
Weirnecke's
42
Symptoms of Weirnecke's
``` Confusion Ataxia Opthalmopegia Nystagmus Peripheral neuropathy ```
43
What will Weirnecke's present to if not Rx
Korsakoff Psychosis which is irreversible
44
What are symptoms of Korsakoff
``` Impairment of recent and remote memory Immediate preserved Impaired learning Disorientated Nystagmus Ataxia ```
45
How do you treat Weirnecke's / Korsakoff
Thiamine | Give even if at risk and no signs
46
What is the neurochemical disturbance in alcohol
Depressant so increased inhibitor signal - GABA | Decreased excitatory - NMDA
47
What is harmful use
>1 months or repeated over 12 months
48
What is dependence 3+ >1 month or repeat
``` >3+ >1 month or repeat Craving Difficulty controlling Tolerance Withdrawal Persistence despite harmful consequence Saline - highest priority Primacy - first thing Narrow repoitre ```
49
What score to assess alcohol withdrawal severity
CIWA
50
What else be needed if someone presents with symptoms of Weirnecke / Korsakoff
CT to exclude subdural

Psychiatry (11 decks)

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