382825
Beschreibung
Mindmap von greenfylde, aktualisiert more than 1 year ago
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Erstellt von greenfylde
vor etwa 11 Jahre
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alcohol misuse (any manifestation)
- alcoholism
- alcoholic: one whose repeated drinking leads to harm in work or social life
- common: (25%) ranging from binge drinking to heavy daily intake
- DENIAL is leading feature- be sure to q relatives
- alcoholic: one whose repeated drinking leads to harm in work or social life
- CAGE questions
- CUT DOWN ever feel like ought to?
- ANNOYED have ppl annoyed you by criticising drinking?
- GUILTY: ever felt about drinking?
- EYE OPENER ever had to steady nerves in morning?
- 2+: sensitivity 43-94%, specific 70-97%
- CUT DOWN ever feel like ought to?
- Organs affected
- Liver
- normal in 50%; GGT up or very up!!
- Fatty liver
- acute + reversible, but may progress to cirrhosis
- also seen in obesity, DM + w/amiodarone
- also seen in obesity, DM + w/amiodarone
- acute + reversible, but may progress to cirrhosis
- alcoholic hepatitis
- TPR up/ anorexia /D+ V /tender hepatomegaly +/- jaundice; bleeding; ascites
- bloods: WCC ++; Urea ++, MCV ++, ACT ++ INR--
- severe? jaundice, encephalopathy, coagulopathy
- 80% progress to cirrhosis (hepatic fail in 10%)
- TPR up/ anorexia /D+ V /tender hepatomegaly +/- jaundice; bleeding; ascites
- cirrhosis
- 5yr survival 48% if drink continues (77%if not)
- biopsy: mallory bodies +/- neutrophil infiltrate
- 5yr survival 48% if drink continues (77%if not)
- normal in 50%; GGT up or very up!!
- CNS
- poor memory/cognition
- multiple high potency vitamins/minerals may reverse
- multiple high potency vitamins/minerals may reverse
- cortical atropy
- retrobulbqar neuropathy
- fits
- falls
- Korsakoff's +/- Wernicke's encephalopathy
- can't learn new info/skills
- lack of insight, personality change
- confabulation
- lack of thiamine
- progress can be halted by stop alc, high doses thiamine, good diet
- progress can be halted by stop alc, high doses thiamine, good diet
- can't learn new info/skills
- wide based gait ,neuropathy, confabulation
- poor memory/cognition
- GI
- obesity, diarrhea, gastric erosions, peptic ulcers, varices, pancreatitis, carcinoma, oral mucosal lesions
- obesity, diarrhea, gastric erosions, peptic ulcers, varices, pancreatitis, carcinoma, oral mucosal lesions
- Blood
- MCV ++,; anemia from: marrow depress, GI
bleed, alcoholism-assoc folate defic, hemolysis,
sideroblastic anemia
- MCV ++,; anemia from: marrow depress, GI
bleed, alcoholism-assoc folate defic, hemolysis,
sideroblastic anemia
- Heart
- arrhythmias, BP++, cardiomyopathy, sudden death in binge drinkers
- arrhythmias, BP++, cardiomyopathy, sudden death in binge drinkers
- Liver
- Withdrawal
- starts 10-72 h after last drink
- signs
- pulse up, BP down, tremor, confusion, fits, hallucinations- may be visual or tactile (small rodents common)
- pulse up, BP down, tremor, confusion, fits, hallucinations- may be visual or tactile (small rodents common)
- consider in any new (<3d) ward pt w/acute confusion
- withdrawal management: admit, do BP + TPR/4h.
Beware BP drop. For 1st 3d give generous
chlordiazepoxide, weaning over 7-14d. (alternative:
diazepam). Vitamins!!!! so don't get brain damaged
w/glucose
- starts 10-72 h after last drink
- Management
- group therapy, self help (ie AA may be
useful espec if self-initiated +
determined. Encourage will to change,
suggestions
- can use drugs to make drink unpleasant, but
need expert as has severe/dangerous SEFx
- can use drugs to make drink unpleasant, but
need expert as has severe/dangerous SEFx
- relapse
- 50% will relapse soon after starting treatment
- 50% will relapse soon after starting treatment
- group therapy, self help (ie AA may be
useful espec if self-initiated +
determined. Encourage will to change,
suggestions
- alcohol contraindics
- driving, hepatitis, cirrhosis, peptic ulcer, drugs
(eg antihistamines, metronidazole), carcinoid,
pregnancy (fetal alch snd - IQ --, short
palpebral fissure, absent philtrim, small eyes)
- driving, hepatitis, cirrhosis, peptic ulcer, drugs
(eg antihistamines, metronidazole), carcinoid,
pregnancy (fetal alch snd - IQ --, short
palpebral fissure, absent philtrim, small eyes)
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