Alcohol Misuse Flashcards by Aimee Love

What are reasons for hospitalisation due to alcohol?

Injury 
Mental health and behavioural disorders
Heart conditions/stroke
Liver disease/pancreatitis
Cancer

How well did you know this?

Not at all

Perfectly

What are the functions of the liver?

Carb metabolism (glycogenesis/glycogenolysis)
Fat metabolism
Protein metabolism (deamination/transamination) & production of albumin
Storage of glucose, iron, copper, vitamins
Synthesis of fibrinogen and thrombopoetin
Production of bile
Metabolism of drugs and alcohol

How well did you know this?

Not at all

Perfectly

What does thrombopoetin do?

Stimulate production of platelets in the bone marrow

How well did you know this?

Not at all

Perfectly

What are Kupffer cells?

Specialised macrophages in the liver

How well did you know this?

Not at all

Perfectly

How does the body process alcohol?

Alcohol absorbed in mouth, oesophagus, stomach, intestines

At liver, alcohol dehydrogenase breaks ethanol into acetaldehyde
Acetaldehyde broken down by aldehyde dehydrogenase into acetate

Acetate broken down into fatty acids, CO2 and water

How well did you know this?

Not at all

Perfectly

How long does it take for a healthy liver to process 1 unit of alcohol?

1 hour

How well did you know this?

Not at all

Perfectly

What happens in chronic consumption of alcohol?

Deposition of triglycerides in liver –> fatty liver disease

Inappropriate activation of stellate cells which produce collagen –> fibrosis and scar tissue

How well did you know this?

Not at all

Perfectly

What is the recommended drinking allowance?

No more than 14 units spread over >3 days

How well did you know this?

Not at all

Perfectly

Consuming >100 units/wk does what?

Puts you at 20% risk of developing serious liver disease

How well did you know this?

Not at all

Perfectly

What are the majority of deaths due to alcohol due to?

Cirrhosis

How well did you know this?

Not at all

Perfectly

What is the progression of alcohol related liver disease?

Normal liver –> steatosis –> hepatosteatosis –> fibrosis –> cirrhosis

Steatosis is reversible!

How well did you know this?

Not at all

Perfectly

Why does alcohol consumption lead to steatosis?

Alcohol is calorie rich and fatty acids are produced from its metabolism - these are deposited around the CENTRAL vein and then the parenchyma

How well did you know this?

Not at all

Perfectly

What are indicators of chronic alcohol use?

Elevated gamma GT
Macrocytosis (enlarged RBCs)
Low platelets 
Elevated ferritin 
Enlarged, smooth edged liver on AUSS

How well did you know this?

Not at all

Perfectly

What changes occur to the liver in alcoholic hepatitis?

Infiltration of liver with leucocytes and necrosis

How well did you know this?

Not at all

Perfectly

What are the symptoms of alcoholic hepatitis?

Hepatomegaly, jaundice, abdominal pain, fever, hepatic decompression

How well did you know this?

Not at all

Perfectly

What can you use to measure 28 day survival without treatment in alcohol hepatitis?

Glasgow Alcoholic Hepatitis Score

Using age, inflammation markers and LFTs

How well did you know this?

Not at all

Perfectly

How do you manage alcoholic hepatitis?

Steroids

Manage infection, nutrition, renal impairment or coagulation problems if they arise

How well did you know this?

Not at all

Perfectly

What changes occur to the liver in liver fibrosis?

Study These Flashcards

Chronic inflammation
Stellate cells activated –> collagen production

Localised fibrosis around the vein and loss of lobule structure

How can you assess the severity of cirrhosis?

Study These Flashcards

Fibroscan –> less elastic = more likely to be cirrhosis

What are the complications of cirrhosis?

Study These Flashcards

Variceal haemorrhage
Encephalopathy
Ascites

What cancer can occur in those with cirrhosis?

Study These Flashcards

Hepatocellular carcinoma

What law controls alcohol use/selling?

Study These Flashcards

Licensing act 2005
Not allowed to sell to U18 or drunk people or people buying on behalf of someone under 18

To have license must have training in dealing with intoxicated people and must record this training for inspection by police scotland

What are some equivalents to 14 units?

Study These Flashcards

6 pints of beer
6 glasses of wine
14 shots

What are the effects of alcohol at lower doses?

Study These Flashcards

Euphoria, increased sociability, reduced anxiety, relaxation

What are the effects of alcohol at higher doses?

Intoxication

Define intoxication

Pathological state induced by a drug/serum/alcohol (poisoning)

What is the ICD-10 criteria for alcohol dependence?

3+ for >1 month/repeadedly over 12 months: - Increased tolerance - Physiological withdrawal - Neglect of other interests - Continued use despite knowledge of harm - Difficulty controlling use - Primacy - Compulsions/cravings

Define withdrawal state

Symptoms relating to the withdrawal of a substance after persistent use of that substance

Define harmful use of alcohol

Pattern of use causing damage to physical/mental health (over >1 month/repeatedly over 12 months)

What are the neurochemical effects of alcohol?

Depressant Enhances inhibitory GABA A, glycine and adenosine Reduces excitatory NDMA glutamate, aspartate Promotes endogenous opioid release and endocannabinoid release

What are the symptoms of alcohol withdrawal?

N/V, tremor, anxiety, weakness, seizures, confusion, agitation, death

What is delirium tremens?

Profound confusion, tremor, agitation, hallucinations, delusions, insomnia, autonomic overactivity Can lead to death (by CV collapse, infection, hyperthermia, seizures, self injury) Usually 48-72h after alcohol stopped

What mortality is associated with delirium tremens?

What kinds of problems does alcohol misuse cause?

``` Physical health Mental health Relationships Employment/financial Legal ```

What is Othello syndrome?

Repeated episodes of jealous, accusations of infidelity, searches for evidence etc. (may be due to schizophrenia, alcohol etc.)

What mental health problems are associated with alcohol?

``` Anxiety Depression Sleep disruption Morbid jealousy Hallucinations Self arm/suicide ```

State some physical health problems with chronic alcohol use

``` Loss of muscle HTN Ulcers/gastritis Brain damage Memory problems Risk of chest infection Liver problems Nerve problems Infertility/impotence ```

What cancers does alcohol misuse predispose to?

Mouth, oesophagus, liver

What is Korsakoff's psychosis?

Thiamine deficiency --> retrograde and anterograde amnesia (immediate recall okay) May also have impaired learning/disorientation, nystagmus, ataxia

What is Wernicke's encephalopathy?

Thiamine deficiency --> ataxia, confusion, opthalmoplegia, nystagmus

What screening tools can you use for alcohol misuse?

CAGE FAST AUDIT PAT

What are the 4 CAGE questions?

Have you tried to cut down? Have you ever been annoyed by people criticising your drinking? Have you ever felt guilty about your drinking? Have you ever needed an eye-opener?

What is involved in the management of alcohol addiction?

Advice, education Support for family and patient CBT, family therapy Social work input (benefits, children protection, housing) Skills trainoing Community support (e.g. AA)Inpatient/residential treatment Medication

What medication is used for alcohol addiction?

Thiamine to prevent Wernicke's/Korsakoff Benzos (chlorodiazepoxide) Aversion Rx - disulfiram Anti-craving Rx - Acamprosate/naltrexone/nalmefene

Alcohol Misuse Flashcards

(44 cards)