Flashcards in Alcohol: the Clinicians Perspective Deck (33)
What are symptoms of mild alcohol withdrawal?
Fine tremor, sweating, anxiety, hyperactivity, increased HR, increased BP, fever, anorexia, nausea, retching.
What are the symptoms of moderate alcohol withdrawal?
Coarse tremor, shaking, agitation, confusion, disorientation, paranoia, seizures, hallucinations.
What are the symptoms of severe alcohol withdrawal?
More severe and prolonged, risk of DT.
Circulatory collapse and death can occur.
What are the symptoms of delirium tremens?
Severe agitation, anxiety, confusion, delusions, hallucinations.
What drug do you give to manage withdrawal?
Diazepam (a benzodiazepine).
What are the features of an alcohol withdrawal seizure?
Sudden cessation/reduction in alcohol 12-24 hours previous.
Clustered over a few hours.
What are the features of an epileptic seizure precipitated by alcohol?
Alcohol ingestion precipitates seizures in susceptible individuals
Usually morning after acute intoxication
Any pattern of seizure.
What type of peripheral neuropathy do you get with alcohol and what are the symptoms?
Sensorimotor axonal polyneuropathy (glove and stocking as peripheral parts of nerves affected first).
Burning, pain, weakness.
Why does alcohol cause peripheral neuropathy?
Direct damage to peripheral nerves from alcohol.
Nutritional deficiencies (thiamine).
What is a compression myopathy and what is it's common name?
Temporary damage to myelin sheath.
Saturday night palsy.
Why do people get radial nerve compression at the humeral head (compression myopathy)?
People sleeping in odd positions.
What are the symptoms of acute myopathy (after binges)?
Myalgia, proximal weakness, swollen tender muscles, raised CK. Recovers over weeks to months.
What are the symptoms of chronic myopathy?
Painless, proximal weakness and atrophy, normal CK, low potassium and phosphate. Incomplete recovery takes months.
What causes Wernicke's encephalopathy?
Thiamine deficiency and cytotoxic oedema in mamillary bodies.
What is the triad of Wernicke's?
Ocular dysfunction (nystagmus -> complete ophthalmoparesis)
What is the treatment for Wernicke's?
What is Korsakoff syndrome?
Cerebral atrophy resulting from WE.
Give the signs and symptoms of Korsakoff syndrome.
Profound anterograde amnesia (unable to retain new info)
Variable retrograde amnesia (episodic memory)
Generally lack insight
What are the keys of Korsakoff treatment and are they effective?
Abstinence and nutrition
Chances of recovery are low
What other neurological problems may alcohol cause?
Dementia, stroke, depression, head injury, cerebellar disease.
Is there a direct link between alcohol and coronary artery disease?
What are the indirect links between alcohol and CAD?
Alcohol increases BP and lipids
More likely to smoke if drink
What kind of a relationship exists between alcohol and cardiovascular mortality?
J-shaped - those who drink a little die less than those who rink none.
What is the pathophysiology of dilated cardiomyopathy?
Alcohol impairs ventricular function (calcium homeostasis, mitochondrial effects, signal transduction).
Prolonged exposure leads to chronic inflammation/fibrosis of myofibrils.
How does alcohol lead to chronic arrhythmias and what ones does it lead to?
Causes electrolyte imbalance leading to a long QT, dilated cardiomyopathy causes atrial and ventricular arrhythmias.
Does alcohol related steatosis cause an abnormal LFT?
What can restore synthetic function in decompensated cirrhosis?
What cancer are you at risk of if you have liver cirrhosis?
What cancers does alcohol increase risk of?
Oral, pharyngeal, laryngeal, oesophageal, colorectal, hepatocellular carcinoma and female breast cancer.