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Chapter Six: Medical Complications. low-risk drinking. No level of drinking is consistently safe Moderate drinking can create health problems Potential problems aggravating medical conditions alcohol-medication interactions. complications chronic use.

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Chapter six medical complications l.jpg

Chapter Six: Medical Complications


Low risk drinking l.jpg
low-risk drinking

  • No level of drinking is consistently safe

  • Moderate drinking can create health problems

  • Potential problems

    • aggravating medical conditions

    • alcohol-medication interactions


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complications chronic use

  • Virtually all body systems affected

  • Result of direct effects of alcohol

  • Result of indirect effects


Gastrointestinal system l.jpg
gastrointestinal system

  • Problems due to alcohol’s irritant properties

  • Possible irritation to

    • esophagus = esophagitis

    • stomach = gastritis and ulcers

    • can lead to nausea and vomiting possibly sufficient to cause tears along GI tract


Pancreas gastrointestinal system cont l.jpg
pancreas gastrointestinal system (cont.)

  • Gland tucked behind stomach and small intestines

  • Produces digestive juices, also contains isles of Langerhans, that produce insulin

  • Alcohol-caused problems

    • acute and chronic pancreatitis

    • diabetes


Liver disease gastrointestinal system cont l.jpg
liver disease gastrointestinal system (cont.)

  • Common medical complication

  • Three major types

    • Acute fatty liver

    • Hepatitis

    • Cirrhosis


Cirrhosis gastrointestinal system cont l.jpg
cirrhosis gastrointestinal system (cont.)

  • Cirrhosis means scarring

  • Result of damage to liver cells

  • Irreversible

  • Mortality of 50% within 5 years if drinking continues

  • Medical complications: coma, esophageal varices, diminished ability to regulate blood glucose levels


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hematological system

  • Each part of blood system affected

    • Red blood cells major function is carrying oxygen

    • White blood cells involved in fighting infection immune system

    • Platelets key to forming blood clots

  • Medical complications: anemia, increased bleeding, higher risk of infection


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cardiovascular system

  • Multiple problems

    • specific effects on heart

    • direct and indirect effects

  • Medical complications

    • alcoholic heart muscle disease

    • arrhythmias

    • beriberi heart disease

    • holiday heart syndrome

    • hypertension

    • stroke


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genitourinary system

  • Kidneys

    • alcohol’s effects due to disordered function elsewhere in body

    • primarily liver disease

  • Glomerulosis

  • Hepato-renal syndrome


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reproductive system males

  • Primarily result of liver disease leads to imbalance of sex hormones

  • Signs and symptoms

    • diminished libido

    • impotence

    • possible sterility

    • “feminization” of features


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reproductive system females

  • Primary cause is liver disease leads to imbalance of sex hormones

  • Signs and symptoms

    • decreased fertility

    • skipped menstrual periods

  • Fetal alcohol syndrome with pregnancy


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fetal alcohol syndrome (FAS)

  • Leading cause of preventable birth defects

  • Not restricted to alcoholic women

  • Threshold around 1 drink per occasion*

    • not an absolute threshold

    • NIAAA recommends no alcohol * Many “drinks” are more than a half oz.


Fetal alcohol syndrome fas cont l.jpg
fetal alcohol syndrome (FAS) (cont.)

  • Alcohol in blood stream passes through placenta to fetus

  • Alcohol interferes with normal fetal development (teratogen)

  • Impact greatest in first several months

  • “Fetal alcohol effects” condition with only some of FAS symptoms


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fetal alcohol syndrome (FAS) (cont)

Features defining FAS

  • lower birth weight

  • small head size

  • “dysmorphic” facial appearance

  • developmental difficulties extending into adulthood


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respiratory system

Direct effects

  • Alters rate of respiration

  • Alters normal pulmonary defenses

    Indirect effects

  • Aspiration pneumonia

  • Increased risk respiratory diseases


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endocrine system

  • Composed of the glands in body

  • Direct effects:

    • via impact on pituitary and

    • impact on individual glands

  • Indirect effects:

    • via liver’s inability to metabolizehormones

  • Medical complications: hyperglycemia, hypoglycemia, water and metabolic imbalances


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skin

Primarily the result of indirect effects

  • Nutritional deficiencies

  • Hematological and liver disorders

  • Aftermath of accidents

  • Rhinophyma (rum nose)

  • Prophyria cutanea tarda


Skeletal system l.jpg
skeletal system

  • Gouty arthritisincreased uric acid from liver disease

  • Degenerative arthritis result of falls and accidents

  • Septic arthritis from infection

  • Osteoporosis loss of minerals  weakening of bones

  • Asceptic necrosis (bone death)


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Central Nervous System

Dependence

  • accompanies long-term heavy use

  • accommodation to chronic presence of alcohol

    Elements of dependence

  • tolerance

  • withdrawal on ceasing or reducing use

  • possible craving


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CNS syndromes (cont.)

  • Pathological idiosyncratic intoxication

  • Organic Brain Diseases

    • Wernicke’s syndrome

    • Korsakoff’s syndrome

    • alcoholic cerebellar degeneration

    • portosystemic encephalopathy


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CNS disorders (cont.)

  • Nerve and muscle damage

  • Subdural hematoma

  • Neuropsychological impairment


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“Abstinence syndrome”

Evidence of dependence

Triggered by relative lowering of blood alcohol level

Four major withdrawal syndromes

hyperarousal

alcoholic hallucinosis

convulsive seizures

delirium tremens

Withdrawal


Hyper arousal withdrawal syndomes cont l.jpg

Earliest and most common withdrawal

Includes —

anxiety

irritability

loss of appetite

rapid heart beat

tremulousness

sweating

rapid pulse

unable to sleep

Basis for early am drinking, to treat withdrawal

Duration

usually subsides in 2-3 days

but irritability and sleep problems can persist

If doesn’t subside, more serious withdrawal

Hyper-arousal Withdrawal Syndomes(cont.)


Alcoholic hallucinosis withdrawal syndromes cont l.jpg
Alcoholic HallucinosisWithdrawal Syndromes(cont.)

  • Occurs in 25% of withdrawal

  • Seen in first 24 hours

  • True hallucinations

  • May include illusions & misinterpretation ofreal stimuli in environment

  • May include nightmares

  • Not evidence of underlying psychiatric problem


Convulsive seizures withdrawal syndromes cont l.jpg
Convulsive Seizures Withdrawal Syndromes(cont.)

  • Used to be called “rum fits”

  • Most common in 12-48 hours after stopping alcohol

  • Generalized, grand mal seizure

  • Most commonly one or two seizures

  • Complication: status epilepticusseizures follow one another

  • Represents serious withdrawalone third of those with seizures go on to have DTs


Delirium tremens withdrawal syndromes cont l.jpg
Delirium TremensWithdrawal Syndromes(cont.)

  • Most serious form of withdrawal

  • Early withdrawal, rather than clearing, worsens

  • Historically up to 20% mortality

  • “Delirium” refers to hallucinations

  • “Tremens” refers to tremulousness, agitation,  CNS activity


Delirium tremens cont withdrawal syndromes cont l.jpg
Delirium Tremens (cont.)Withdrawal Syndromes(cont.)

  • Profuse sweating, hypertension, respiratory problems, fluid loss, agitation

  • Delusions and hallucinations

  • Lasts from 1 day to 1 week

  • Risk factors —

    • history of withdrawal problems

    • drinking a fifth or more for a week

    • heavy drinking for 10 or more years

    • recent abuse of other sedatives


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Management of withdrawal

  • Detoxification

  • Goal: safe withdrawal of alcohol

  • Benzodiazepines commonly used

  • Substitute drug for alcohol, and then tapering dose

  • Liver function considered in selecting medication

  • If multiple drugs being abused, sequential withdrawal


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alcohol -cocaine interactions

  • Cocaine and alcohol popular combination

    • believed to “extend” the cocaine high

  • Physiological basis for this perception

  • Alcohol alters metabolism of cocaine

  • 20% of cocaine metabolized into cocaethylene

  • Cocaethylene

    • has psychoactive properties similar to cocaine

    • longer half-life than cocaine


Alcohol cocaine interactions cont l.jpg
alcohol -cocaine interactions(cont.)

  • Alcohol  cocaine increases heart rate

  • Alcohol  cocaine increases blood pressure

  • Increase proportionate to level of cocaine

  • 20 times greater risk of sudden death

  • Increased risk of violence and suicide