alcohol misuse (any manifestation)

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

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	Created by greenfylde almost 11 years ago