Chapter Six: Medical Complications

1. Chapter Six: Medical Complications

2. low-risk drinking • No level of drinking is consistently safe • Moderate drinking can create health problems • Potential problems • aggravating medical conditions • alcohol-medication interactions

3. complications chronic use • Virtually all body systems affected • Result of direct effects of alcohol • Result of indirect effects

4. 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

5. 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

6. liver disease gastrointestinal system (cont.) • Common medical complication • Three major types • Acute fatty liver • Hepatitis • Cirrhosis

7. 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

8. 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

9. 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

10. genitourinary system • Kidneys • alcohol’s effects due to disordered function elsewhere in body • primarily liver disease • Glomerulosis • Hepato-renal syndrome

11. 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

12. 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

13. 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.

14. 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

15. fetal alcohol syndrome (FAS) (cont) Features defining FAS • lower birth weight • small head size • “dysmorphic” facial appearance • developmental difficulties extending into adulthood

16. respiratory system Direct effects • Alters rate of respiration • Alters normal pulmonary defenses Indirect effects • Aspiration pneumonia • Increased risk respiratory diseases

17. 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

18. skin Primarily the result of indirect effects • Nutritional deficiencies • Hematological and liver disorders • Aftermath of accidents • Rhinophyma (rum nose) • Prophyria cutanea tarda

19. 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)

20. 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

21. CNS syndromes (cont.) • Pathological idiosyncratic intoxication • Organic Brain Diseases • Wernicke’s syndrome • Korsakoff’s syndrome • alcoholic cerebellar degeneration • portosystemic encephalopathy

22. CNS disorders (cont.) • Nerve and muscle damage • Subdural hematoma • Neuropsychological impairment

23. “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

24. 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.)

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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