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 1st 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
| DISEASE |
AST |
ALT |
AST:ALT |
MCV |
| Alcoholic liver disease |
|
|
>2 |
|
| Hepatitis C |
or ? |
|
<1 |
? |
| Non-alcoholic liver disease |
|
|
<1 |
or ? |