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Alcoholism (Organs affected (CNS (Wernicke's encephalopathy…
Alcoholism
Screening
info: repeated drinking leads to harm in work or social life
CAGE
C: felt you need to cut down?
A: annoyed by others criticising your drinking
G: Guilty about your drinking?
E: eye opener to steady nerves?
Organs affected
Trauma
while intoxicated
Liver
:left_right_arrow:in 50%
Fatty liver
reversible but can progress to cirrhosis if continue to drink
Alcoholic hepatitis
Cirrhosis
CNS
Self neglect
:arrow_down:memory & cognition
cortical atophy
retrobulbar neuropathy
fits
falls
wide based gait
neuropathy
Wernicke's encephalopathy
Korsakoff's / confabulation
Gut
Obesity
Diarrhoea & Vomiting
Gastric erosions
peptic ulcers
varices
pancreatitis
cancer
oesaphageal rupture
Blood
:arrow_up:MCV
from marrow depression
GI bleeding
:arrow_down: folate
haemolysis
sideroblastic anaemia
Heart
Arrhythmias
:arrow_up:BP
Cardiomyopathy
sudden death in binge drinkers
Withdrawal
Starts 10-72 hours after last drink
Signs
:arrow_up:pulse
:arrow_down: BP
tremor
consfusion
fits
hallucinations
delirium tremens
visual or tactile - bugs
consider it in any new patient <=3d with acute confusion
Management
Admit
Obs 4 hourly
Thiamine
first 3 days give
chlordiazepoxide
Treatment
Refer to community alcohol team
group therapy
self help
reduce drinking over time with regular follow up
Detoxification
In community:
Chlordiazepoxide
over one week
In hospital
Maintenance
Acamprosate
helps to :arrow_down: craving Sx
Disulfiram
produces :tired_face: when drinks
Vitamin B1 supplements