Alcohol symposium

Question 1

Define alcohol

Answer 1

“Alcohol” is non-specific, and includes methanol, ethanol, propanol etc.

In usual parlance, however, alcohol often means ethanol.

Question 2

Name two enzymes involved in the metabolism of alcohol

Answer 2

Alcohol dehydrogenase

Aldehyde dehydrogenase

Question 3

What is ethanol metabolised to?

Answer 3

Acetate

Question 4

What can happen if you drink methanol?

Answer 4

Can become blind since when metabolised by the same enzymes in same way of ethanol to form formic acid

Question 5

Describe the redox alteration caused by alcohol

Answer 5

Stimulates fatty acid synthesis, which are then esterified with glycerol and stored as triglyceride
NADH interferes with gluconeogenesis

Question 6

Describe the oxidant stress alcohol causes

Answer 6

Lipid peroxidation which is associated with both acute tissue damage & fibrosis
Free radicals attack cellular & mitochondrial DNA causing deletions & mutations

Question 7

What is 1 unit?

Answer 7

1 Unit = 10mL or 8g of pure alcohol

Question 8

What is the current national limit for alcohol a week?

Answer 8

14 units

Question 9

What is the current limit for driving and alcohol?

Answer 9

≤ 2-3 units in females

≤ 3-4 units in men

Question 10

Describe alcoholic ketoacidosis

Answer 10

Metabolic acidosis with increased anion gap.

Chronic alcoholics, binge with little nutrition intake & with persistent vomiting which might cause metabolic alkalosis.

Pathophysiology :  
Extracellular volume depletion
Glycogen depletion
Increased NADH/NAD ratio
Insulin suppressed
Lipolysis and ketones increased (beta hydroxybutyrate)

Question 11

How can ethanol cause hypoglycaemia? State the treatment of this

Answer 11

Ethanol causes hypoglycaemia through:
decreased intake of glucose (CHO),
depletion of glycogen,
blockade of gluconeogenesis

Prompt treatment with glucose is life-saving

Need to give parenteral thiamine as well to prevent CNS damage in case there is also thiamine deficiency

Question 12

List the endocrine effects of alcohol

Answer 12

Decreased testosterone (testicular atrophy)

Pseudo Cushings

Metabolic Syndrome and Dyslipidaemia

Question 13

List some general nutrition issues caused by ethanol

Answer 13

Low calcium (diet, decreased vitamin D)

Low phosphate (diet, increased PTH)

Low Mg, K (diet, hyperaldosteronism)

Question 14

Can alcohol cause hypertension?

Answer 14

Yes but mechanism not clearly understood

Question 15

How does alcohol cause thiamine deficiency?

Answer 15

Ethanol interferes with GI absorption

Hepatic dysfunction, which hinders storage and activation

Malnourishment

Question 16

List some functions of the liver

Answer 16

Fat metabolism 
Carbohydrate metabolism 
Protein metabolism  
Storage 
Intermediate metabolism 
Secretion

Question 17

List some hepatic responses to injury

Answer 17

INFLAMMATION
CELL DEATH
REGENERATION
FIBROSIS (SCARRING)

Question 18

What can excessive alcohol intake cause?

Answer 18

Fatty liver (steatosis) - early, reversible
Alcoholic (steato-) hepatitis with chronic abuse, reversible
Fibrosis (scarring)
CIRRHOSIS

Question 19

List the complications of cirrhosis

Answer 19

PROGRESSIVE LIVER FAILURE

HEPATOCELLULAR CARCINOMA

PORTAL HYPERTENSION

Question 20

What is liver failure?

Answer 20

REDUCED HEPATOCYTE FUNCTION
Decreased protein synthesis
Decreased detoxification

Question 21

What is portal hypertension?

Answer 21

ASCITES
CONGESTIVE SPLENOMEGALY
HEPATIC ENCEPHALOPATHY
PORTOSYSTEMIC SHUNTS

Question 22

Which approaches are likely to be the most effective for reducing alcohol-related harm at the population level?

Answer 22

Targeting high-risk individuals
Genetic predisposition
Family history
Earlier drinkers

Question 23

Describe the information, motivation, behavioural model

Answer 23

If people are to adhere to guidelines then they must have:

information - be exposed to and understand the guidelines
motivation - consider the guidelines to be meaningful / relevant
behavioural skills - know how to the apply guidelines to own behaviour

Question 24

What is the purpose of personalised feedback?

Answer 24

personalised feedback does help to improve
	information
	motivation
	behavioural skills 						
… but it is resource intensive

Question 25

What is good about dry january?

Answer 25

Abstinence challenges allow people to - perform “behavioural experiments” - boost motivation - enhance behavioural skills - may have longer-lasting effects - encourage discussions / “change the conversation” about alcohol

Question 26

Why is a psychosocial approach required?

Answer 26

qualitative (and quantitative) studies show the importance of social context and social factors + behavioural experiments interventions and attempts to motivate people must acknowledge this ? concerns about health ? concerns about fitting in ? concerns about reputation, image, weight, etc. benefits of change - message framing

Question 27

In terms of earnings who is (a) more likely to drink and (b) more likely to be admitted to hospital as a result of alcohol?

Answer 27

(a) high earners | (b) those from a deprived population

Question 28

Describe the drinking habits of young people

Answer 28

Less likely to drink but when they do they drink more heavily

Question 29

Describe the relationship between alcohol and violence

Answer 29

Domestic violence - 1/3 alcohol related RTAs – 1 in 7 of those killed on UK roads Impact on children – collateral – 1/5 of all calls to Childline are related to parents alcohol consumption

Question 30

How is consumption estimated?

Answer 30

1. Reported consumption: population surveys – e.g. Health Survey of England, Safe and well Schools Survey 2. Taxation data from HMRC Consistently underestimated by 40 - 60% One third of UK population are drinking above hazardous levels

Question 31

Give examples of policies to reduce consumption and limit harm

Answer 31

Minimum Unit pricing Sensible on strength Cumulative impact zone

Question 32

What is alcohol withdrawal?

Answer 32

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

Question 33

List some symptoms of alcohol withdrawal

Answer 33

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

Question 34

Describe the difference between planned and unplanned alcohol withdrawal

Answer 34

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

Question 35

When do the symptoms of alcohol withdrawal appear after admission?

Answer 35

Often occurs 2-3 days after admission

Question 36

Which drugs are used to manage alcohol withdrawal?

Answer 36

DIAZEPAM: e.g. 10-20mg qds with reducing dose over 5-10 days CHLORDIAZEPOXIDE

Question 37

List some potential hazards of managing alcohol withdrawal

Answer 37

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

Question 38

Describe delirium

Answer 38

Disturbance of consciousness Change in cognition or a perceptual disturbance (hallucination) Onset of hours to days, and tendency to fluctuate. Behaviour overactive or underactive; sleep often disturbed, loss of normal circadian rhythm. Other features include: disorganized thinking, poor memory, delusions and mood lability

Question 39

What is the importance of thiamine (vitamin B 1)?

Answer 39

Glucose and lipid metabolism Production of amino acids Production of glucose derived neurotransmitters

Question 40

How is thiamine deficiency caused?

Answer 40

Alcoholism Excessive vomiting Famine

Question 41

What is Wernicke’s Encephalopathy? State the signs

Answer 41

Brain damage: Multiple small haemorrhages especially in upper brainstem, hypothalamus and thalamus, mamillary bodies Signs include confusion, eye signs and ataxia

Question 42

What is Korsakoff’s Psychosis?

Answer 42

Permanent brain damage Severe short term memory loss Confabulation

Question 43

Describe how people become alcohol dependant and why they experience withdrawal symptoms

Answer 43

Symptoms of alcohol withdrawal occur because alcohol is a central nervous system depressant. Alcohol simultaneously enhances inhibitory tone and inhibits excitatory tone. Only the constant presence of ethanol preserves homeostasis. Abrupt cessation unmasks the adaptive responses to chronic ethanol use resulting in over activity of the central nervous system. If you drink a lot, for a long time, your central nervous system adapts by working harder to maintain equilibrium. If you then suddenly stop drinking, it continues to overwork which gives rise to withdrawal symptoms.

Question 44

Describe how a non medical detox works

Answer 44

- Planned reduction - Drink diaries - Stabilisation - Gradually reduce (5 units per day?) - Consider form of alcohol, strength and size of ‘vessel’ - Which drinks to not have? (e.g. start later, await withdrawal symptoms, plan day)