Alcoholism

Organs affected

• Liver
  • Raised ?-GT
  • Fatty liver disease – acute and reversible but may progress to cirrhosis if drinking continues (also seen in obesity, DM and amiodarone
  • Alcoholic hepatitis – 80% progress to cirrhosis
  • Cirrhosis – 50% 5 year survival if drinking continues
• CNS
  • Poor memory/cognition
  • Cortical atrophy
  • Fits
  • Falls
  • Wide based gait
  • Confabulation
  • Korsakoff’s and Wernicke’s encephalopathy
• GI tract
  • Obesity
  • Diarrhoea
  • Gastric erosions/ peptic ulcers
  • Varices
  • Pancreatitis acute and chronic
  • Carcinoma
  • Oral mucosal lesions
• Blood
  • Raised MCV
  • Anaemia from;
    • BM suppression
    • GI bleeding
    • Alcoholism associated folate deficiency
    • Haemolysis
• Heart
  • Arrhythmias
  • Raised BP
  • Cardiomyopathy

Withdrawl

• Starts 10-72hr after the last drink
• Signs – tachycardia, hypotension, tremor, confusion, fits, hallucinations (delirium tremens)

Fetal alcohol syndrome

• Low IQ, short palpebral fissure, absent philtrum and small eyes

Management

• Admit
• Chlordiazeproxide for 1^st 3d (alternative diazepam)
• Vitamins may be needed
• Treating establish alcoholics – group therapy or self-help
• To prevent relapse;
  • Acamprosate – may help with anxiety, insomnia and craving
  • Disulfiram – causes acetaldehyde build up with unpleasant side effects – flushing, headache, palpitations

Patterns of lab tests in alcoholic and other liver disease