Term
| 1. cancers a/w alcohol intake |
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Definition
cancers of the oral cavity, larynx, pharynx, esophagus,liver and lung
(think everything between mouth and stomach and then the liver)
may be a/w gastric, colon, pancreatic, and breast ca
(below stomach, and things missed (breasts) |
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Term
| 2. Most common cause of cirrhosis and esophageal varices? |
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Definition
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Term
| 3. Relationship b/t alcohol and accidental or intentional death? |
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Definition
50% of fatal car accidents
67% of drownings, 67% of homicides
35% of suicides
70-80% of deaths caused by fire |
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Term
| 4. What happens if you give glucose to an alcohol w/o first giving thiamine? |
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Definition
You may precipitate Wernicke's encephalopathy.
Always give thiamine before glucose in alcoholics! |
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Term
| 5.a. Acute encephalopathy w/ opthalmoplegia, nystagmus, ataxia, and/or confusion |
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Definition
Wernicke syndrome
reversible with thiamine |
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Term
| 5b. Chronic psychosis with anterograde amnesia (inability to form new memories) and confabulation (lying) |
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Definition
Korsakoff syndrome
-damage to the mamillary bodies and thalamic nuclei
-irreversible |
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Term
| 5c. How are Wernicke and Korsakoff syndromes similar? |
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Definition
| Both result from thiamine deficiency. |
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Term
| 6. T or F: Alcohol withdrawal can be fatal. |
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Definition
True. It can result in death, so treat alcohol withdrawal on an inpatient basis.
(mortality rate of up to 10% in some older studies) |
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Term
| 7. How is alcohol withdrawal treated? |
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Definition
With benzodiazepines (rare cases, barbiturates).
Taper dose over days until sx have resolved. |
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Term
8a. Stages and time of alcohol withdrawal:
-tremors, sweating, hyperreflexia, seizures?
-auditory and visual hallucinations and illusions w/o autonomic signs?
-hallucinations and illusions, confusion, poor sleep, and autonomic lability (sweating, increased pulse and temp.) |
|
Definition
-acute withdrawal syndrome: 12-48 hrs. after last drink
-alcoholic hallucinosis: 24-72 hrs. after last drink
-delirium tremens: 2-7 days after last drink |
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Term
| 8b. Why might a patient develop delirium on postoperative day 2 but be fine before the surgery? |
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Definition
| Delirium tremens can occur several days after the last drink. The patient could be a secret alcoholic and is thus in alcohol withdrawal, experiencing delirium tremens, assuming other causes of delirium have been r/o. |
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Term
| 9. Abdominal wall varices (caput medusae), esophageal varices, testicular atrophy, encephalopathy, hemorrhoids (internal), jaundice, ascites, palmar erythema, spider angiomas, gynecomastia, asterixis, prolonged prothrombin time, hyperbilirubinemia, hypoalbuminemia, anemia (macrocytic usually) |
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Definition
| physical stigmata of liver disease in alcoholics. |
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Term
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Definition
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Term
10. What can chronic alcohol intake cause?
-GI?
-Liver?
-Neurologic?
-Cardiac?
-Muscular? |
|
Definition
Gastritis, Mallory-Weiss tears, Pancreatitis
Fatty change in liver, Hepatitis, Cirrhosis
Peripheral neuropathy (due to thiamine deficiency and direct effect); Wernicke or Korsakoff syndrome, Cerebellar degeneration (ataxia, past-pointing)
Dilated cardiomyopathy
Rhabdomyolysis (acute or chronic) |
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Term
| 10b. Histology slide: empty areas, displaced nuclei to periphery of cell. |
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Definition
Fatty change of liver.
Causes include: alcohol, DM, obesity, chronic hypoxia. |
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Term
| 11. classic ratio of AST to ALT in alcoholic hepatitis |
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Definition
2:1
AST = aspartate aminotransferase, aka serum glutamate oxaloacetate transaminase (SGOT)
ALT: alanine aminotransferase; serum glutamate pyruvate transaminase (SGPT)
Note: other causes of hepatits are a/w opposite ratio or equal elevation of both AST and ALT |
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Term
| 12. Best treatment for alcoholism? |
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Definition
Alcoholics Anonymous or other peer-based support groups.
Disulfiram is helpful (alcohol dehydrogenase enzyme inhibitor that makes ppl sick when they drink)
Note: metronidazole and certain cephalosporins have similar effect on those who drink alcohol. |
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Term
| 13. Mental retardation, microcephaly, microphthalmia, short palpebral fissures, midfacial hypoplasia, cardiac defects. |
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Definition
Fetal alcohol syndrome.
Affects 1:3000 births.
Alcohol is the most common cause of preventable mental retardation. |
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Term
| 14. Epidemiology of alcohol abuse? |
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Definition
10-15% of the population abuses alcohol.
-more common in men
(genetic component most easily passed from father to son) |
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Term
| 15a. Alcoholic w/ pneumonia? |
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Definition
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Term
| 15b. thick, mucoid capsules mentioned in culture report of pneumonia patient |
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Definition
Klebsiella- aspiration pneumonia, common in alcoholics.
Other organisms: enteric- anaerobes, E.coli, Strep, Staph |
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Term
| 16. T or F. Alcohol can precipitate hypoglycemia. |
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Definition
| T. Give thiamine first and then glucose in an alcoholic. |
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Term
| 17. What electrolyte and vitamin/mineral abnormalities would you expect in alcoholics? |
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Definition
Electrolytes: low magnesium, potassium sodium; elevated uric acid/gout
Vitamins: deficiencies of folate, thiamine |
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Term
| 18. How to treat bleeding esophageal varices? |
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Definition
1st: ABCs (airway, breathing, circulation)- stabilize w/ IV fluids and blood if needed
2nd: endoscopy to find varices causing upper GI bleed
3rd: sclerotherapy of the veins: cauterization, banding, or vasopressin
4th: if you must choose, try TIPS (transjugular intrahepatic portasystemic shunt) over an open surgical portacaval shunt
Note: most physiologic shunt among surgical options: splenorenal shunt
3rd: |
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