Alcohol Misuse

Question 1

What are the 6 criteria for alcohol dependence

Answer 1

1. Cravings/compulsions to take
2. Difficulty controlling use/loss of control
3. Primacy/takes priority
4. Increased tolerance
5. Physiological withdrawal on reduction/cessation
6. Persistence despite harmful consequences

Question 2

For how many and how long do the 6 criteria need to persist to diagnose dependence of alcohol

Answer 2

3 or more of the criteria
For >1month
Or
Repeatedly over 12 months

Question 3

Describe clinical features of withdrawal

Answer 3

Tremor
Weakness
Nausea
Vomiting
Anxiety
Seizures
Confusion, Agitation 
Death

Question 4

Screening tools for Alcohol addiction

Answer 4

CAGE
FAST
AUDIT
PAT

Question 5

Describe the CAGE screening tool

Answer 5

CAGE (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 6

Which screening tool is often used by GPs

Answer 6

FAST

Question 7

Triad of Wernicke’s Encephalopathy

Answer 7

Confusion
Ataxia
Opthalmoplegia (e.g nystagmus)

Question 8

What is the cause of Wernicke’s Encephalopathy

Answer 8

Thiamine deficiency

Question 9

Alcohol Hx questions to ask

Answer 9

Type 
Units 
Has this increased
How long 
Pattern of drinking (typical day)

Question 10

Prevention of Encephalopathy Rx

Answer 10

Thiamine

Question 11

Rx for Wernicke’s Encephalopathy

Answer 11

IV Thiamine

Question 12

Rx for withdrawal

Answer 12

Benzodiazepines (Chlordiazepoxide)

Question 13

Which aversion/deterrent medication can be given as Rx

Answer 13

Disulfiram (Antabuse)

Question 14

What is the action of aversion/deterrent medication

Answer 14

Means if the patient drinks alcohol having taken this medication they will feel awful

Question 15

Which anti-craving medication can be given as Rx

Answer 15

Acamprosate (Campral)
Naltrexone
Nalmefene (Baclofen)

Question 16

Psycho-social approach for alcohol addiction recovery

Answer 16

Support for patient and family
Psychological help (e.g. CBT, group therapy)
Social work input (benefits, housing, child protection)
Skills training
Community Support (eg AA, ADA)
Inpatient or residential treatment

Question 17

What is delirium tremens

Answer 17

Profound acute confusion
48-72hrs after alcohol is withdrawn
Admit

Question 18

Symptoms of delirium tremens

Answer 18

Tremors
Agitation 
Hallucinations 
Delusions
Sleeplessness
Autonomic over activity

Question 19

Effects of higher disease of alcohol

Answer 19

Intoxication 
Impaired attention and judgement 
Unsteadiness
Flushing 
Nystagmus 
Mood instability 
Disinhibition 
Slurring 
Stupor 
Unconsciousness

Question 20

Effects of low doses of alcohol

Answer 20

Euphoria
anxiety
Relaxation
Sociability

Question 21

Effects of alcohol on mental health

Answer 21

Anxiety 
Depression 
Sleep disturbance
 Morbid jealousy 
Alcoholic hallucinosis 
Deliberate self-injuryy 
Suicidal thoughts/acts

Question 22

Effects of alcohol on the brain

Answer 22

Brain damage 
Loss of memory 
Hallucinations 
Fits 
Dementia

Question 23

Effects of alcohol on the chest

Answer 23

Risk of chest infection

Question 24

Effects of alcohol on the liver

Answer 24

Swollen liver
Hepatitis
Cirrhosis

Question 25

Effects of alcohol on the nervous system

Answer 25

Paraesthesia Numbness Trembling hands

Question 26

Effects of alcohol on the risks of STI

Answer 26

HIV and AIDS

Question 27

Effects of alcohol on the endocrine system

Answer 27

Poro control DM

Question 28

Effects of alcohol on the GI system

Answer 28

Ulcers Gastritis Haematemsis Pancreatitis

Question 29

Effects of alcohol on sexual system

Answer 29

Impotence in men | Infertility in women

Question 30

How many units of alcohol does a healthy liver process in 1hr

Answer 30

1 unit per 1hr

Question 31

What is the recommended drinking units for M and F

Answer 31

both M and F | 14 units

Question 32

What is alcoholic fatty liver

Answer 32

When fat is deposited in and around the liver

Question 33

What are the potential outcomes of alcoholic fatty liver

Answer 33

Reversible Can become inflamed steatohepatitis Can develop cirrhosis

Question 34

Which score is used to measure alcoholic hepatitis

Answer 34

Glasgow Alcoholic Hepaittis Scroe

Question 35

What does a GAHs score > 9 indicate with 30 day mortality

Answer 35

30 day mortality Without steroids = 48% With steroids = 22%

Question 36

What does a GAHs score >9 indicate with 84 day mortality

Answer 36

Without steroids - 62% | Within steroids - 41%

Question 37

What is the toxic product of alcohol breakdown

Answer 37

Acetaldehyde

Question 38

What happens to acetaldehyde in alcohol problems

Answer 38

There is an overload/increased amount causing harm

Question 39

Signs of chronic liver disease

Answer 39

``` Spider naevi Palmar erythema Gynaecomastia Loss of axillary and pubic hair Ascites Encephalopathy Jaundice ```

Question 40

What does a raised GTT often relate to

Answer 40

Alcohol

Question 41

What causes hepatic encephalopathy

Answer 41

High levels of ammonia built up in the system | Crosses the BBB

Question 42

How is hepatic encephalopathy graded

Answer 42

1-4 1 = mild confusion 4 = coma

Question 43

Rx for alcoholic hepatitis

Answer 43

Steroids Management of infection Nutrition ABSTINENCE

Question 44

What is the first stage of alcohol related liver disease

Answer 44

Fatty liver | Steatosis

Question 45

Is fatty liver disease reversible

Answer 45

yes with abstinence

Question 46

Rx for hepatocellular cancer

Answer 46

Surgical resection Liver Tx Radiofrequency/microwave ablation Chemotherapy

Question 47

What is the most common reason for liver Tx in Scotland

Answer 47

Alcohol related liver disease