True or False

It is UK as to whether alcoholism is behavioral or genetic.

True...but,

Some say it is 60% genetic and 40% environmental.

True or False

2/3 of Americans drink ETOH.

Usually by its adverse consequences:

• DWI
• Abuse
• Work mishaps/absentism.

True or False

500,000 Americans have end stage liver disease (aka Cirrhosis).

Define Alcoholism.

(It is important to note the difference beween alcoholism and alcohol abuse)

Define Alcohol Abuse:

How is it different than alcoholsim?

• 25% enters from stomach
• 75% enters from intestines.
• 70 kg male metabolizes 5-10 gr of alcohol/hr
• Average drink is 12-15 gr.
• Alcoholics get 50% of calories from ETOH.

True or False

There is no blood-brain barrier to alcohol.

True or False

Addiction to alcohol maybe a rapid or slow process.

True or False

Dependence on alcohol is faster in women and teens.

True or False

It may take 20-25y for alcoholism to run its course.

True or False

It can be 5-15y until the problems of Alcoholism surface.

True or False

25% of pts undergoing  alcohol withdrawl die

• Hypokalemia
• Hypocalcemia
• Hypomagnesemia (causes Torsades)
• Hypophosphoremia
• Ketoacidosis
• Respiratory Acidosis

• blackouts
• Wernicke's Encephalopathy
• Korsadoff's Syndrome
• Cerebellar degeneration
• Dementia
• CVA (especially in young)
• SAH

1. When BAC is decreased by 25%    AND/OR
2. 48-96h after drinking stopped.

Yes, seizures may occur while still intoxicated.

• peripheral neuropathies
• hepatitis/cirrhosis
• fatty liver
• GI bleed
• rupture of esophagus
• pancreatitis
• malnutrition
• gastritis/peptic ulcers

• abnomal rhythms
• HTN
• chronic heart muscle damage

• aspiration pneumonia
• Fx ribs(r/t fall)----pneumothorax
• TB
• impaired diaphramic expansion r/t ascities.

Not separate diseases. Korsakoff's is Psy component of Wernickes.

They are a combonation of occular & ataxic & amnesic s/s caused by Thiamine deficiency.

• gray matter legions
• swelling of optic discs
• retinal hemorrhages
• Ataxia: heel to toe gait (wobble)
• Paralysis of eye movements
• acute or slow onset

Inability to recall NEW INFORMATION despite a normal LOC.

These pts compensate with confabulation.

(this is also seen with non-alcoholic thiamine deficiency)

Thiamine 50 mgm IV

or

Thiamine 100 mgm PO

*delay of tx can cause inabilty to return to mental competency.

True or False

Only 10-20% of alcoholics develop liver damage.

Fatty liver

• usually asymptomatic
• hepatomegaly
• reversable if alcohol stopped
• mild enzyme elevations.

True or False

Alcoholic hepatitis cannot be detected clinically & is due to ETOH & poor nutrition.

True or False

Women > Men get alcholic hepatitis.

• anorexia
• wt loss
• fever
• N/V
• ab pain
• portal HTN
• elevated AST/ALT/AP/Bili/Pro time
• decreased and smaller platelets
• NEED LIVER Bx FOR Dx

Alcoholic Hepatitis has a poor prognosis if:

• Not resloved with Vit K
• High increase in bilirubin
• Leukocytosis
• Increased BUN/Cre

• Prednisone: 40 mgm OD x 28d
• Androgens: Oxandrolone x 30d
• Vit K/nutritional support
• Rehab: AA
• Check for multi substance abuse
• Check for TB.

End stage liver disease (ESLD)

50% of pts are alive 48m after dx

irreversable damage.

Women> men

What is the tx for cirrhosis?

• stop drinking-decreases mortality by 60%
• nutritional support
• Steroids-controversial
• liver transplant

• sepsis
• malignancy
• renal failure
• respiratory failure
• cardiac failure

• prediction of fatal outcome
• prediction that pt will remain sober (6m prior also to be considered)

• due to hepatic failure
• Na+ retention by kidneys
• decreased plasma oncotic pressure
• increased pressure on portal vein
• develop edema of abdomen & LE

• Sodium restriction (1000mg daily)
• BR
• restrict fluids
• ALDACTONE: Diuretics.(watch for K elevation, if it goes high, switch to Lasix for a couple of doses)

True or False

Concerning the pt with ascities, the abdomen cannot absorb more than 700-900 ml/day

• remove up to 3-5L
• send specimen for analysis
• remove slowly
• give albumin
• give FFP
• restrict fluids to prevent hyponatremia

Denver shunt: peritoneal-venous shunt

TIPS: Transjugular intrahepatic portosystemic shunt.

True or False

Esophageal varicies are responsible for 50% of all bleeds.

True

1/3 of pts die from esophageal varicies.

the severity of portal HTN=severity of  bleed

Tx: endoscopy with scleral therapy

(65% have recurrent bleed)

• ulcerations
• strictures
• perforation
• sepsis
• 40% fever

Inderal: prevents rebleed in 25% of cases

no increase in survival

List s/s of minor alcohol withdrawl.

• tremens
• anorexia
• nausea, irritability
• starts a few hrs after d/c alcohol(maybe delayed)
• resolves in 48h

Serax (Oxazepam) is used to treat anxiety disorders or alcohol withdrawal symptoms.

• seizures (focal/partial)
• photophobia
• always consider CNS legions in alcoholics
• always assume subdural hemotoma until CAT is done

True or False

Alcoholics often fall causing head and neck injuries.

True

True or False

All alcoholics have a decreased drug clearance.

True or False

DTs have a high mortality rate

• Sepsis
• lyte imbalances
• pneumonia
• hypoxema
• TB
• HIV

Campral is indicated for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation. Treatment with Campral should be part of a comprehensive management program that includes psychosocial support. In clinical settings and clinical practice, Campral has been proven to help alcohol-dependent patients maintain abstinence and reduce the incidence and severity of relapse.

• 62% have some adverse reaction
• anorexia, asthenia, diarrhea
• anxiety, depression, insomnia
• dizziness, pruritis.

1. Early onset (survivors): started drinking earlier in life. 2/3 of elderly drinkers.
2. Intermittant or binge drinkers: only occasionally but to excess.
3. Late onset (reactors): began drinking later in life---related to life events (death,pain, etc.)

True or False

ETOH has a greater effect on the elderly due to lower water to fat ratio & decreased hepatic blood flow.

• men > women
• wide based gait
• myopathy---proximal muscle weakness
• alcoholic cardiac myopathy
• have elevated CPK.

• Occular changes: nystagmus/6th nerve palsy.
• Gait disorder: ataxia, wide based gait, falling.
• Mental changes: quiet confusion, disorder of memory confabulation. Unable to learn new material.

Subdural hemotoma.

CT without contrast.

Barrett's esophagus is a condition in which the esophagus changes so that some of its lining is replaced by a type of tissue similar to that normally found in the intestine. This process is called intestinal metaplasia.

While Barrett's esophagus may cause no symptoms itself, a small number of people with this condition develop a relatively rare but often deadly type of cancer of the esophagus called esophageal adenocarcinoma. Barrett's esophagus is estimated to affect about 700,000 adults in the United States. It is associated with the very common condition gastroesophageal reflux disease or GERD.