alcohol symposium Flashcards

Question

effect of thiamine deficiency

Answer 1

cofactor in glycolysis and TCA | also in PPP

Answer 2

hepatic lobules with portal triads (portal vein, hepatic arteriole and bile duct) central vein, sinusoids flow mixed blood from triad giving hepatocytes time to interact with blood as it flows to central vein flows via zones 1, 2, 3 (o2 dec, met activity inc) most vulnerable to injury

Answer 3

To make a diagnosis Stage / grade the disease To monitor treatment To inform prognosis percutaneous or venous approach

Answer 4

Microvesicular fatty change Extend of fibrosis Amount of MD bodies Intrahepatic cholestasis

Answer 5

Steatosis (fatty liver) macrovesicular microvesicular Steatohepatitis ballooning of hepatocytes inflammation via neutrophils necrosis of hepatocytes Mallory Denk bodies Fibrosis / cirrhosis

Answer 6

single large fat droplets to osmicated fat (black droplets in varying size) fat not seen under microscope, stained specially

Answer 7

hepatocytes distended by large number of fat droplets surrounding central nuclei, also can have enlarged mt

Answer 8

lack of cytoplasmic keratins (bigger and cytoplasm fragments in early stage of necrosis), plus clumped aggregates

Answer 9

neutrophils (small purple dots surrounding hepatocytes) | heal by fibrosis and scarring

Answer 10

dead hepatocytes clump together

Answer 11

permanent long term and irreversible | little oxygen, lots of metabolism, red collagen fibres

Answer 12

inflammation and necrosis cause increase in cytokines and growth factors (TGF-beta, MCP-1) that activate fibroblasts/myofibroblasts to deposit collagen (Disse’s space) centrilobular fibrosis - reversible septal fibrosis - increasingly irreversible

Answer 13

Macronodular cirrhosis/portal hypertension nodules surrounded by thick fibrosis to inc PV pressure can also lead to fibrosis

Answer 14

impaired intestinal function and malabsorption splenomegaly with anaemia and thrombocytopenia portal bypass circulations - haemorrhoids, caput medusae (paraumbilical veins engorged), oesophageal veins (varices) ``` vasodilatation and compensatory inc in CO toxic metabolites (NH3, fatty acids, biogenic amines) bypass the liver and may cause portosystemic (hepatic) encephalopathy ```

Answer 15

in “wet” drinking cultures, there is integration of alcohol into daily life as a consumer commodity like any other; in dry drinking cultures, alcohol is marginalized as an especially powerful and hazardous commodity

Answer 16

``` People drink alcohol for various reasons e.g., Drinking Motives Questionnaire measures enhancement social conformity coping ```

Answer 17

short term - poisoning, accidents/injury, violence, antisocial behaviour long term - cirrhosis, cancers, stroke, premature death + suicide also hangovers, ALDH-2 deficiency, religion and culture

Answer 18

efforts focus on motives for drinking and not drinking gain framed or loss framed eg IMB or psychosocial (need social context and factors eg health, fitting in, reputation and image)

Answer 19

people tend to have poor knowledge and lack the requisite skills to stop so personalised feedback on drink pouring - improves knowledge - enhances behavioural skills - reduces alcohol intake

Answer 20

cluster-randomised-controlled trial and follow-up survey greater use of glasses resulted in - better knowledge of guidelines - better capacity to monitor intake - better attitudes toward using guidelines ... but no significant reductions in intake

Answer 21

``` Abstinence challenges allow people to - perform behavioural experiments - boost motivation - enhance behavioural skills Benefits of not drinking majority report better sleep, concentration, saving money + a minority report weight loss Enduring effects 40% drink less 6 months later (50% return to previous drinking) and greater sense of control over drinking ```

Answer 22

Physiological dependence The ‘need’ to drink to avoid unpleasant symptoms - ‘Relief Drinking’ Delirium Tremens

Answer 23

``` Tremor/shaking Sweating Tachycardia Nausea Agitation Seizures Visual hallucinations ```

Answer 24

Planned: in community or in hospital/detox facility Unplanned: known alcohol problems + another medical problem or alcohol history not known in patient presenting with a separate problem

Answer 25

Importance of alcohol history in all inpatients High index of suspicion Often occurs 2-3 days after admission Look for corroborative evidence

Answer 26

diazepam | chlordiazepoxide (RSCH and PRH)

Answer 27

Severe liver disease - precipitation of hepatic encephalopathy Respiratory depression Reluctance to prescribe more Concomitant alcohol consumption

Answer 28

Disturbance of consciousness Change in cognition or a perceptual disturbance (hallucination) Tendency to fluctuate Behaviour overactive or underactive Other features: disorganized thinking, poor memory, delusions and mood lability

Answer 29

``` Any infection Drug side effect Hypoxia Drug overdose Alcohol intoxication Wernicke encephalopathy Hypoglycaemia Meningitis / encephalitis Psychiatric illness Head injury Constipation (elderly) Hepatic encephalopathy Etc…etc…. ```

Answer 30

``` WERNICKE-KORSAKOFF SYNDROME Wernicke’s Encephalopathy Korsakoff’s Psychosis THIAMINE treated with oral or IV thiamine (check glucose first) ```

Answer 31

``` Wheat Yeast Nuts Oatmeal Potatoes Pork Marmite intake 1mg, body stores 30mg deficiency after a month of none ```

Answer 32

``` Co-enzyme: Glucose and lipid metabolism Production of amino acids Production of glucose derived neurotransmitters ```

Answer 33

Alcoholism commonest cause (inadequate intake, inhibition of active intestinal absorption by alcohol and malnutrition) Chronic vomiting e.g. hyperemesis gravidarum Famine

Answer 34

Confusion Eye Signs - opthalmoplegia and nystagmus Ataxia 10% cases, under diagnosed

Answer 35

Brain damage: Multiple small haemorrhages especially in upper brainstem, hypothalamus and thalamus, mamillary bodies 20% mortality if untreated

Answer 36

Permanent brain damage Severe short term memory loss Confabulation

alcohol symposium Flashcards

(60 cards)