alcohol symposium Flashcards
(45 cards)
1
Q
what is the CMO guidance for alcohol consumption? 3
A
- low risk: less than 14 units a week, spread over 3 or more days
- Increased risk: men 14-50 units a week, women 14-35 units a week
- High risk: men over 50 units a week, women over 35 units a week, risk or alcohol related problems
2
Q
what are the proportions of people who drink in Brighton and Hove? 2
A
- 1/5 adults drink over 14 units of alcohol nationally
- 2/5 in Brighton and Hove
3
Q
what factors are associated with children having a drink in the last week? 7
A
- Parents don’t discourage drinking
- Older pupils
- Recent drug use
- Drinkers at home
- Smoking
- White ethnicity
- Playing truant
4
Q
describe the statistics for children in Brighton and Hove? 5
A
- 73% of 15 year olds in the UK have drunk alcohol
- 15% of 11 year olds
- 11% of 15 years olds in Brighton and Hove drink regularly
-24% of 15-year-olds in Brighton and Hove have tried cannabis
5
Q
describe the statistics around death with alcohol? 6
A
- Alcohol misuse is the biggest factor for early death in England in adults under 50
- It can lead to cardiovascular disease, liver disease and more
- Globally there are 2.5 million deaths a year, 5.1% of the global burden of disease and injury is attributable to alcohol
- 1/3 cases of domestic violence are alcohol related
- 1/7 RTA are due to alcohol
- 1/5 of all calls to ChildLine are related to parents’ alcohol consumption
6
Q
who can influence alcohol consumption? 7
A
- Individual factors
- Family
- Culture and community
- Socioeconomics
- Religion
- Country/laws
- Taxes
7
Q
name some policies to limit consumption and reduce harm? 2
A
- Taxation to limit affordability and raise revenue
- Regulation and legislation- alcohol promotion and marketing, price, drink driving
8
Q
describe minimum unit pricing? 4
A
- 50p minimum price per unit
- Increases the price of cheap high alcohol drinks
- Reduces harm
- Not a tax
9
Q
describe sensible on strength? 7
A
- Licensed businesses voluntarily stop selling super strength beer, lager and cider about 6% refusals systems, CCTV, documented training
- Tackle anti-social behaviours
- Improve health for vulnerable drinkers
- Identify problem areas in the city
- Reduces crime and disorder
- Reduced intimidation and violence to staff
- Not an anti-alcohol scheme
10
Q
describe views on drinking with different cultures? 2
A
- 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 marginalised as an especially powerful and hazardous commodity
11
Q
why do people drink? 4
A
- Various reasons
- Enhancement- to feel better, to do things otherwise impossible
- Social- to be sociable, to celebrate parties
- Conformity- because other do, to fit in coping- because it helps you forget about problems
12
Q
why don’t some people drink? 5
A
- Short term harm= alcohol poisoning, accidents and injury, violence, antisocial behaviours
- Long term harm= cirrhosis, cancers, stroke, premature death and suicide
- Hangovers
- Aldehyde dehydrogenase 2 (ALDH-2) deficiency
- Religion/ culture
13
Q
can we change how people drink? 2
A
- Efforts must focus on motives for drinking and not drinking
- Messages may be gained-framed or loss-framed
14
Q
what do people need to adhere to guidelines? 3
A
- Information= be exposed to and understand the guidelines
- Motivation= consider the guidelines to be meaningful/ relevant
- Behavioural skills= know how to apply the guidelines to own behaviour
15
Q
describe awareness/ screening/ brief intervention? 5
A
- People tend to have poor knowledge and lack the requisite skills
- Personalised feedback on drink pouring:
- Improved knowledge
- Enhances behavioural skills
- Reduces alcohol intake
16
Q
describe the outcomes of dry January? 3
A
- Abstinence challenges allows people to perform behavioural experiments, boot motivation and enhance behavioural skills
- Benefits of not drinking- majority report better sleep, concentration, saving money and a minority report weight loss
- Enduring effects- 40% drink less 6 months later and have a greater sense of control over drinking
17
Q
why is a psychosocial approach required? 5
A
- Qualitative studies show the importance of social context and social factors
- Interventions and attempts to motivate people must acknowledge this
- Concerns about health
- Concerns about fitting in
- Concerns about reputation, image, weight
18
Q
what is alcohol dehydrogenase polymorphism? 2
A
- Several isoforms of this enzyme are present, with variable activity in individuals depending on genetic makeup and other factors
- Individuals of Asian descent who have the B2 ADH isoform, metabolise ethanol 20% faster than northern Europeans who possess the B1 ADH
19
Q
describe the effect of alcohol dehydrogenase polymorphism on the redox state? 3
A
- Both alcohol dehydrogenase and aldehyde dehydrogenase reactions reduce NAD to NADH
- Increases= lactate: pyruvate ratio, beta-hydroxybutyrate: acetoacetate ratio
- Inhibits: glycolysis, citric acid cycle (ketogenesis), fatty acid production, gluconeogenesis
20
Q
describe the toxic and metabolic effects of alcohol dehydrogenase polymorphism? 2
A
- Oxidant stress= lipid peroxidation which is associated with acute tissue damage and fibrosis
- Free radicals attack cellular and mitochondrial DNA causing deletions and mutations
21
Q
describe methanol metabolism? 7
A
- methanol \+alcohol dehydrogensase -formaldehyde \+aldehyde dehydrogenase - formic acid \+ folate - Co2 + H2O
22
Q
describe ethylene glycol (antifreeze) poisoning? 8
A
- ethylkene glycol \+alcohol dehydrogenase - glycoaldehyde \+ aldehyde dehydrogenase - glycolic acid \+lactate dehydrogenase and glycolic acid oxidase - glyoxylic acid - glycine, oxalate acid, formic acid, alpha-hydroxy-beta-ketoadipate
23
Q
what is one unit of alcohol?
A
10ml or 8g of pure alcohol
24
Q
describe ethanol and driving? 5
A
- Legal limit for driving in the UK is blood ethanol <80mg/dl
- <2-3 units in females
- <3-4 units in men
- Drinking any alcohol can still be too much if you are going to drive, operate machinery, swim or do strenuous physical activity
- Pregnant women or women trying to conceive should not drink alcohol as ethanol crosses the placenta and alcohol can seriously affect foetal development (foetal alcohol syndrome)
25
what is alcoholic ketoacidosis? 6
- Metabolic acidosis with increased anion gap
- Typically occurs in chronic alcoholics who binge with little nutrition intake:
Pathophysiology:
- glycogen depletion/ inhibited gluconeogenesis
- lipolysis and ketones increased (beta hydroxybutyrate)
- insulin suppressed
- extracellular volumes depletion/ dehydration/ stress- increase counter regulatory hormones further supressing insulin
26
describe hypoglycaemia? 6
- ethanol causes hypoglycaemia through:
- decreased intake of glucose (CHO)
- depletion of glycogen
- blockade of gluconeogenesis
- .
- Prompt treatment with glucose is lifesaving
- Need to give parenteral thiamine as well to prevent CNS damage in case there is also thiamine deficiency
27
name some typical liver function tests? 4
- Gamma glutamyl transferase (GGT) increased by liver enzyme function
- Transaminases (ALT and AST) increased by hepatocellular damage
- Globulin increased in cirrhosis
- Bilirubin and INR increased, and albumin decreased by liver failure
28
what can cause a thiamine deficiency? 3
- Ethanol interferes with Gi absorption
- Hepatic dysfunction, which hinders storage and activation
- Malnourishment
29
name some other relevant blood tests for alcohol related issues? 5
- Macrocytosis- raised MCV in a full blood count
- Raised serum ferritin concentration
- Hyperuricaemia
- Hypertriglyceridemia
- Increased carbohydrate-deficient transferrin of CDT
30
describe alcohol and hypertension? 6
- Impairment of the baroreceptors (which sense blood pressure)
- Increase of sympathetic activity
- Stimulation of the renin-angiotensin-aldosterone system
- An increase in plasma control
- An increase of intracellular calcium with subsequent increase in vascular reactivity
- Endothelial (inhibition of endothelium-dependent nitric oxide production
31
why do we do liver biopsies? 9
- To make a diagnosis
- Stage and grade the disease
- To monitor treatment
- To inform prognosis
- Increased risk of progression
- Micro vesicular fatty change
- Extend of fibrosis
- Amount of MD bodies
- Intrahepatic cholestasis
32
describe the symptoms of alcoholic liver disease? 12
- Steatosis.
- Macrovesicular
- Microvesicular
- .
- Steatohepatitis;
- Ballooning of hepatocytes
- Inflammation of neutrophils
- Necrosis of hepatocytes
- Mallory denk bodies
- .
- Fibrosis/ cirrhosis
- Inflammation and necrosis cause an increase in cytokines and growth factors (TGF-beta, MCP-1) that activate fibroblasts/ myofibroblasts to deposit collagen (disse’s space)
- Cellular fibrosis- reversible
- Septal fibrosis- increasingly irreversible
33
portal hypertension consequences? 8
- Impaired intestinal function and malabsorption
- Splenomegaly with anaemia and thrombocytopaenia
- Portal bypass circulations:
- Haemorrhoids
- Caput medusae
- Oesophageal veins
- .
- Vasodilation and compensatory increase in cardiac output
- Toxic metabolites (NH3, fatty acids, biogenic amines) bypass the liver and may cause portosystemic (hepatic) encephalopathy
34
describe alcohol withdrawal? 3
- Physiological dependence
- The need to drink to avoid unpleasant symptoms- relief drinking
- Delirium tremens
35
what are the symptoms of alcohol withdrawal? 7
- Tremor/shaki
- Sweating
- Tachycardia
- Nausea
- Agitation
- Seizures
- Visual hallu
36
describe planned and unplanned alcohol withdrawal? 4
Planned:
- In community
- In hospital/ detox facility
Unplanned:
- Known alcohol problems and another medical problem
- Alcohol history not known in patient presenting with a separate problem
37
describe alcohol withdrawal managements? 2
| describe the potential hazards of management? 4
- Chlordiazepoxide- used at RSCH and PRH
- Diazepam
Potential hazards of management:
- Severe liver disease- precipitation of hepatic encephalopathy
- Respiratory depression
- Reluctance to prescribe more
- Concomitant alcohol consumption
38
what is delirium? 8
- Disturbances of consciousness
- Change in cognition or a perceptual disturbance (hallucination)
- Tendency to fluctuate
- Behaviour overactive or underactive
- Disorganised thinking
- Poor memory
- Delusions
- Mood lability
39
name some other causes of delirium? 12
- Any infection
- Drug side effect
- Hypoxia
- Drug overdose
- Alcohol intoxication
- Wernicke encephalopathy
- Hypoglycaemia
- Meningitis/ encephalitis
- Psychiatric illness
- Head injury
- Constipation
- Hepatic encephalopathy
40
describe Wernicke's encephalopathy? 2
- Brain damaged: multiple small haemorrhages especially in upper brainstem, hypothalamus and thalamus, mamillary bodies
- 20% mortality if untreated
41
describe Korsakoff's psychosis? 3
- Permanent brain damage
- Sever short term memory loss
- Confabulation
42
what is the importance of thiamine?
- Confusion
- Eye signs
- Ataxia
- Only seen in 10% of cases
- Underdiagnosed
43
describe Wernicke-Korsakoff syndrome? 4
- Can be precipitated and rapidly worsened with introduction of nutrition or administration of IV 5% dextrose
- Any available thiamine in the brain is utilised in the metabolism of glucose leading to sudden complete deficiency
- Give parenteral thiamine before dextrose of nutrition
- Always check glucose level first
44
what is the treatment for Wernicke-Korsakoff syndrome? 4
- PABRINEX= thiamine 250mg and others
- Give IV for 25 days depending on response
- Rarely causes anaphylaxis
- Continue oral thiamine and other vitamins after initial treatment
45
describe thiamine? 3
coenzyme? 3
causes of deficiency? 3
- Vitamin B1
- Wheat, yeast, nuts, oatmeal, potatoes, pork, marmite
- Deficiency starts a month after a thiamine free diet
Co-enzyme:
- Glucose and lipid metabolism
- Production of amino acids
- Production of glucose derived neurotransmitters
Causes of thiamine deficiency:
- Alcoholism is the commonest cause
- Chronic vomiting
- famine
