Alcoholism

An alcoholic is one whose problematic patter n of alcohol use leads to clinically significant impairment or distress, manifested by multiple psychosocial, behavioural or physiological features.

Denial is a leading feature

Causes/Factors

No confirmed causes but suspicions

• Genetic inherited susceptibility to alcohol’s effects, impaired ability to digest alcohol, increased disposition to anxiety, frustration and Depression
• Psychological causes

Symptoms

Liver - normal in 50%, $\uparrow$ GGT.

• Fatty liver; acute and reversible but may progress to Cirrhosis if drinking continues
• Alcoholic Hepatitis; 80% progress to Cirrhosis
• Liver Cirrhosis; 5 yr survival: 48% if drinking continues 77% if stops.

CNS

• Self neglect
• Poor memory/cognition (high potency vitamins IM may reverse)
• Cortical atrophy
• Fits, falls and wide-based gait
• Confabulation/Korsakoff’s $\pm$ Wernicke’s encephalopathy

Gut

• Obesity
• Gastric erosions, Peptic ulcers
• Varices
• Pancreatitis
• Oesophageal rupture

Blood

• Anaemia from marrow Depression, GI bleeding, alcoholism-associated folate deficiency, haemolysis, sideroblastic Anaemia

Heart

• Arrhythmias
• High BP
• Coronary Artery Disease
• Cardiomyopathy
• Sudden death

Withdrawal

Starts 10-72 hrs after last drink. Consider in any new ward patient with acute confusion

Signs - $\uparrow$ HR, $\downarrow$ BP, tremor, confusion, fits, hallucinations

Management

Admit only if complicating or coexisting medical problems require treatment. Beware of BP. Offer resources available to support people trying to give up alcohol

Complications/red Flags

50% will relapse soon after treatment