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Sem 4, case 3 (pancreatitis) > alcohol use and abuse (lecture) > Flashcards

alcohol use and abuse (lecture) Flashcards

(58 cards)

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1
Q

How many deaths are related to alcohol abuse each year ?

A

3 million worldwide

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2
Q

Where does alcohol abuse rank in the leading causes of death ?

A

7th leading cause of death

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3
Q

Which age range is most likely to present with alcohol dependence/harm ?

A

35 - 54

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4
Q

How does alcohol interact with sleep?

A

decreases the quality of sleep by interrupting the sleep cycle

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5
Q

What is dipsomania?

A

alcoholism characterised by intermittent cravings for alcohol

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6
Q

What is Potomania ?

A

electrolyte disturbance brought bout by the dilution effect of drinking lots of beer

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7
Q

What are the ICD-11 criteria for diagnosing alcohol dependence

A
  • disordered regulation/control of alcohol use
  • repeated/continuous use of alcohol
  • strong internal drive to use alcohol
  • prioritisation of alcohol over other activities
  • persistent use despite harms
  • present for 12 months (or 1 month if very serious/continuous)

= chronically relapsing disorder

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8
Q

Which neurotransmitter system is down regulated by alcohol ?

A

GABA-A

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9
Q

Which neurotransmitter system is up regulated by alcohol ?

A

Glutamate

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10
Q

What is involved in the CAGE alcohol questionnaire ?

A

C - has patient ever felt a need to cut down on their drinking ?
A - have people annoyed them by criticising their habits ?
G - have they ever felt guilty about drinking ?
E - has patient used alcohol as an eye-opener = first thing in the morning to steady nerves/reduce hangover etc

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11
Q

Is the CAGE questionnaire seen as an effective method of assessing alcohol dependance ?

A

Not really, better than nothing but the ICD-11 criteria and WHO AUDIT are better methods

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12
Q

Which tool is considered the gold standard method of diagnosing alcohol dependence ?

A

WHO AUDIT
(FAST version in a&e)

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13
Q

What is the UK guidance for ‘safe drinking’ ?

A

14 units per week, spread over 3 days at least

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14
Q

What does an ABV of 12% mean in terms of how much alcohol is in that bottle?

A

12% ABV = 12% of the bottle is alcohol

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15
Q

How much pure alcohol (ml and g) is in 1 unit ?

A

10ml = 8g

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16
Q

What is a quick way to estimate units ?

A

ABV in 1000ml = units

e.g…
1000mls of 5% beer = 5 units
500mls of 10% wine = 5 units

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17
Q

What effect does frequent binge drinking at 18-25yrs old have on future risk of alcohol dependence ?

A

2-3x higher risk

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18
Q

How many calories are there in 1g of pure alcohol ?

A

7.1 calories

(almost double that of 1g of carbs)

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19
Q

What does the ‘J shaped curve’ in alcohol study show about alcohol and mortality ?

A
  • some alcohol is protective against mortality
  • on the whole, the more drinks per day = higher mortality risk

this study has been debunked now

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20
Q

What are some effects of alcohol on the oesophagus ?

A
  • increased cancer risk (esp. squamous cell carcinoma)
  • oesophageal varices (enlarged veins) associated with liver disease
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21
Q

How might oesophageal varices present ?

A
  • drop in Hb due to varices bleeding
  • raised urea
  • coffee-ground vomit
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22
Q

What are some effects of alcohol on the stomach ?

A
  • acute gastritis
  • acute ulceration
  • chronic peptic ulceration
  • portal gastropathy
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23
Q

What are the mechanisms of alcohol related liver disease ?

A
  • direct toxic effects
  • indirect metabolite effect
  • causes activation of free radicals
  • causes induction of enzyme systems
  • causes nutritional deficiencies (B12, thiamine)
  • causes liver function impairment
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24
Q

What are the effects of alcohol on the pancreas ?

Study These Flashcards
A
  • acute pancreatitis
  • chronic pancreatitis
25
How does acute pancreatitis present ?
- severe abdominal pain - radiating to back - nausea/vomiting - greatly elevated serum amylase
26
How does chronic pancreatitis present ?
- intermittent **severe upper abdominal and back pain** - **weight loss** - exocrine tissue replaced by **fibrosis** - leads of pancreatic **malabsorption** (steatorrhoea, reduced vitamins) - relative preservation of endocrine tissue
27
What % of heavy drinkers progress to alcoholic hepatitis or cirrhosis ?
10-20 %
28
By how much does >9 units/day increase a **womans** risk of alcohol liver disease ?
>9 units/day = **12x increased risk** in women
29
By how much does >9 units/day increase a **mans** risk of alcohol liver disease ?
>9 units/day = **4x increased risk** in men
30
Are men or women at greater risk of alcohol liver disease ?
**women** are at higher risk, even at lower amounts of alcohol
31
What does obesity do to the risk of developing alcohol liver disease ?
obesity **doubles** the risk
32
What is the progression of alcoholic liver disease ?
1. acute fatty change *reversible* 2. hepatic fibrosis *reversible* 3. cirrhosis *irreversible* 4. hepatic decompression *fatal* *acute hepatitis can occur along the way*
33
What are some physical presentations of liver failure ?
- jaundice - ascites (very round belly)
34
What are some effects of alcohol on the heart ?
- atrial fibrillation - MI (heart attack) - congestive heart failure (cardiomyopathy)
35
What are some neuropsychiatric disorders associated with alcohol dependance ?
- **seizures** in withdrawal (10% mortality) - **delirium tremens** = delirium/hallucinations in withdrawal - **wernicke’s encephalopathy** = acute delirium, ataxia, ophthalmoplegia - **korsakoff’s psychosis** = chronic tried of short term memory loss, confabulation, ataxia (secondary to thiamine deficiency) - **polyneuropathy** (secondary to B12/thiamine deficiency)
36
How does delirium tremens present ?
**delirium with hallucinations** and autonomic disturbances in alcohol withdrawal confusion, paranoia etc
37
How does Wernicke’s encephalopathy present ?
acute: - delirium - ataxia - ophthalmoplegia
38
How does Korsakoff’s psychosis present ?
chronic triad of: - short term memory loss - confabulation - ataxia *doesn’t have to be all 3*
39
When is the peak incidence of siezures within a withdrawal period ?
1-2 days after cessation of drinking
40
Does delirium tremens present early or late in the withdrawal period from alcohol ?
later
41
How does the severity of withdrawal symptoms change with each relapse ?
withdrawal symptoms **get worse** with each withdrawal period
42
What effect does regular drinking have on GABA-A receptor function?
the body **down regulates GABA-A receptors**, because alcohol is a GABA-A agonist so the body thinks there’s plenty of it
43
What effect does regular drinking have on NMDA receptor function?
the body **up regulates NMDA receptors** because alcohol is an NMDA (glutamate) antagonist
44
What is the mechanism of alcohol inducing seizures ?
The imbalance between GABA-A and glutamate, befuase alcohol… - down regulates GABA-A receptors - up regulates NMDA receptors
45
What drugs can be used to reduce chances of alcohol induced seizures ?
**benzodiazepines** (for GABA-A system) - chlordiazepoxide - diazepam **Thiamine** (for NMDA system)
46
What is in the drug Pabrinex ?
thiamine
47
Which drug is used in alcohol relapse prevention ?
Acamprosate
48
What is myopathy ?
weakness and dysfunction in skeletal muscle
49
Which muscles are most affected by myopathy as a result of alcohol dependence ?
proximal muscles in **pelvic girdle**
50
What is the physiology of thrombocytopenia as a result of alcohol dependence ?
- alcohol is toxic in bone marrow = leads to **reduced normal cell levels** - effects on the liver leads to **folate deficiency** which affects blood cells
51
What is thrombocytopenia?
platelet deficiency
52
What is pancytopenia ?
deficiency of all major cells in blood *white, red, platelets*
53
Describe the process of alcohol metabolism …
1. **Ethanol —> acetaldehyde** via - alcohol dehydrogenase - catalase - P4502E1(microsomes) 2. **Acetaldehyde —> acetate** via aldehyde dehydrogenase
54
Which step of alcohol metabolism does the drug Disulfiram inhibit ?
acetaldehyde —> acetate
55
Which enzyme does the drug Disulfiram inhibit ?
aldehyde dehydrogenase
56
What is the reaction like if a person drinks while on disulfiram ?
Bad reaction - nausea - tachycardia - palpitations
57
What is the idea behind prescribing disulfiram to stop alcohol dependence ?
the drug interacts with alcohol metabolism in a bad way so **the effects are so unpleasant that people will stop drinking** on their own accord
58
What are some non-medication methods of reducing alcohol dependence ?
- patient makes a **drink diary** - consider **behaviour changes** - assess **trigger points** - swap to a **lower strength alcohol** - don’t go cold turkey - drink at a lower level to **prevent withdrawal symptoms** - refer to **drug/drink services**

Sem 4, case 3 (pancreatitis) (4 decks)

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