Monday, March 14, 2011

Alcoholism


Alcoholism

Definition
Alcoholism and alcohol abuse
o Regular and excessive use of alcohol with concomitant social, interpersonal, legal, occupational, and/or physical problems or
o Repeated use in hazardous situations such as driving
Alcohol dependence
o Repeated alcohol-related difficulties in at least 3 areas of functioning that cluster together over any 12-month period
o Regular use of alcohol has resulted in a state of physiologic tolerance.

Symptoms & Signs
Most patients with alcoholism do not have dramatic physical symptoms.
o Instead present with psychosocial difficulties
 Marital difficulties
 Job problems (tardiness, absenteeism)
 Legal problems resulting from driving while intoxicated
o Patients may describe a host of difficulties but may deny that they have a problem with alcohol abuse.
o Denial is a characteristic symptom of alcoholism.
"CAGE" questionnaire: any positive answer indicates a high probability of alcoholism
o Blackouts
 Episode of temporary anterograde amnesia associated with alcohol use
 Occurs in ~35% of drinkers
o Sleep disturbances
 Deficiency in rapid eye movement and deep sleep results in prominent and sometimes disturbing dreams later in the night.
o Sleep apnea
 75% of alcoholic men over age 60
 Relaxes muscles in the pharynx
o Impairment in judgment and coordination
 At least half of patients with physical trauma have evidence of substance-related impairment.
 In the U.S., 40% of drinkers have at some time driven while intoxicated.
o Peripheral neuropathy
 Chronic high doses of alcohol; occurs in 5–15% of alcoholics
o Cerebellar degeneration
1% of alcoholics
 Syndrome of progressive unsteady stance and gait often accompanied by mild nystagmus
2 Alcoholism
o Alcohol-induced mood disorder
 Intense sadness lasting for days to weeks in the midst of heavy drinking in 40% of alcoholics
o Alcohol-induced anxiety disorder
 Temporary severe anxiety in 10–30% of alcoholics
 Often begins during alcohol withdrawal
 Can persist for many months after cessation of drinking
o Alcohol-induced psychotic disorder
 Auditory hallucinations and/or paranoid delusions with a clear sensorium
GI findings
o Esophagus and stomach
 Inflammation of the esophagus and stomach
 Epigastric distress
 GI bleeding
o Pancreas and liver
 Incidence of acute pancreatitis (~25 per 1000 per year) almost 3-fold higher than in the general population
 Repeated exposure to ethanol leads to:
 Fatty accumulation in the liver
 Alcohol-induced hepatitis
 Perivenular sclerosis
 Cirrhosis (15–20%)
 Chronic pancreatitis
Cardiovascular findings
o Chronic heavy drinking
 Mild to moderate hypertension
 Cardiomyopathy
 One-third of cases of cardiomyopathy are alcohol induced.
 Atrial or ventricular arrhythmias, especially paroxysmal tachycardia
 Occurs after a drinking binge in individuals showing no other evidence of heart disease: "holiday heart"
Genitourinary system changes; sexual function
o Acutely (modest alcohol dose: blood alcohol concentrations of ≤100 mg/dL)
 Increases sexual drive and decreases erectile capacity in men
o Chronic alcoholism in men
 Irreversible testicular atrophy with concomitant shrinkage of the seminiferous tubules, decreases in ejaculate volume, lower sperm count
o Repeated ingestion of high doses of ethanol by women
 Amenorrhea
 Decrease in ovarian size
 Absence of corpora lutea with associated infertility
 Spontaneous abortions
Musculoskeletal findings
o Acute alcoholic myopathy
 Condition improves, but might not disappear with abstinence.
o Effects of repeated heavy drinking
 Alteration in calcium metabolism
 Lower bone density
 Increased risk for fractures and osteonecrosis of the femoral head
Alcoholism 3
Alcohol-withdrawal syndrome
o Withdrawal symptoms generally begin within 5–10 hours of decreasing ethanol intake, peak in intensity on day 2 or 3, and improve by day 4 or 5.
o Anxiety, insomnia, and mild levels of autonomic dysfunction may persist to some degree for ≥6 months; may contribute to the tendency to return to drinking.


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