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    2do trabajo ingles 2do trabajo ingles Document Transcript

    • Introduction Alcoholism is the addiction to or dependency upon drinking excessive amounts ofalcoholic beverages.[1] Since the late 20th century, it has been considered an addictive disorder. It is characterized by compulsive and uncontrolled consumption of alcohol, usually to the detriment of the drinkers health, personal relationships, and social standing. Like other drug addictions, alcoholism is medically defined as a treatable disease. -2-
    • ALCOHOL-RELATED DISEASES Alcohol withdrawalSet of symptoms that can occur when a person suddenly stops drinking after beendrinking too much alcohol every day.CausesAlcohol withdrawal occurs more frequently inadults but can occur in teenagers or children.The more you drink each day is more likely toexhibit the symptoms of alcohol withdrawalwhen stopping.SymptomsThe alcohol withdrawal symptoms usually occur within 5 to 10 hours after the lastdrink, but can occur days later. Symptoms worsen in 48 to 72 hours and may continuefor weeks.Common symptoms include:• Anxiety or nervousness• Depression• Trouble thinking clearly• Fatigue• Irritability• shocks or tremors• Ups and downs in mood• Nightmares Other symptoms may include: • Clammy skin • Pupils dilated • Headache • Insomnia • Loss of appetite • Nausea and vomiting • Pale • Rapid heart rate • Trembling hands and other body parts -3-
    • Exams and Tests The doctor will perform a physical exam. This may reveal: • Abnormal eye movements • Abnormal heart rhythms • Insufficiency of body fluids (dehydration) • Fever • Rapid breathing • Rapid heart rate • Hands trembling You can perform blood and urine tests as a drug test.TreatmentTreatment goals include:• To reduce withdrawal symptoms or withdrawal.• Prevent complications.• Therapy to get you to stop drinking (abstinence).HOSPITAL DETOXIFICATIONPeople with alcohol withdrawal symptoms from mild to severe may need hospitaltreatment in a hospital or other facility that treats this type of withdrawal.Treatment may include:• Monitor blood pressure, body temperature, heart rate and blood levels of differentchemicals in the body.• Liquids or medications through a vein (IV).• Sedation using drugs called benzodiazepines until withdrawal is complete.OUTPATIENT TREATMENTIf you have symptoms of alcohol withdrawal may need mild to moderate outpatienttreatment in a hospital or other facility that treats this type of withdrawal. You willneed someone to commit to stay with you during this process and you can watch. Theyneed daily visits to a doctor until you stabilize. -4-
    • Alcoholic liver diseaseAlcoholic liver disease is damage to the liver and its function due to alcohol abuse.CausesAlcoholic liver disease usually occurs after years of drinking too much. The longer thealcohol use has occurred, and the more alcohol that was consumed, the greater thelikelihood of developing liver disease.Alcohol may cause swelling and inflammation (hepatitis) in the liver. Over time, thiscan lead to scarring and then cirrhosis of the liver. Cirrhosis is the final phase ofalcoholic liver disease.Other important factors include: Alcoholic liver disease may be more common in some families This disease does not occur in all heavy drinkers You do not have to get drunk for the disease to develop Women may be more susceptible than men People who drink too much, too often do not get enough healthy foods and nutrients. Poor nutrition may make liver disease worse.Acute alcoholic hepatitis may be caused by binge drinking (five drinks for men, fourdrinks for women). It may be life-threatening.SymptomsSymptoms vary based on the severity of the disease. They are usually worse after arecent period of heavy drinking.Symptoms may not be present until the disease is advanced.General symptoms include: Abdominal pain and tenderness Dry mouth and increased thirst Fatigue Jaundice Loss of appetite Nausea Swelling or fluid buildup in the legs (edema) and in the abdomen (ascites) when cirrhosis is present Weight loss -5-
    • Skin changes include: Abnormally dark or light skin Redness on feet or hands Small, red spider-like blood vessels on the skin Yellow color in the skin, mucus membranes, or eyes (jaundice)Abnormal bleeding: Bloody, dark black, or tarry bowel movements (melena) Nosebleeds or bleeding gums Vomiting blood or material that looks like coffee groundsBrain and nervous system symptoms: Agitation (being stirred up, excited, or irritable) Changing mood Confusion (encephalopathy) Periods of decreased alertness or awareness Hallucinations Impaired short- or long-term memory Pain, numbness, or tingling in the arms or legs Problems paying attention or concentrating Poor judgment Slow, sluggish movementsOther symptoms that can occur with this disease: Breast development in males Light-headedness or fainting, especially when rising to standing position Paleness Exams and Tests Complete blood count (CBC) Liver biopsy Liver function tests such as ALP -6-
    • Tests to rule out other diseases include: Abdominal CT scan Blood tests for other causes of liver disease Ultrasound of the abdomenTreatmentThe most important part of treatment is to stop using alcohol completely. If livercirrhosis has not yet occurred, the liver can heal if you stop drinking alcohol.An alcohol rehabilitation program or counseling may be necessary to break the alcoholaddiction. Vitamins, especially B-complex and folic acid, can help reverse malnutrition.If cirrhosis develops, you will need to manage the complications of cirrhosis. You mayneed a liver transplant. CIRRHOSISCirrhosis is the result of damage accumulated in the liver, characterized by theaccumulation of fibrosis ("scars") in liver tissue and decreased functioning liver tissue.These changes in liver structure and interfere with normal functioning of the liver,causing serious complications in the circulation of blood through the liver.CAUSESThere are many causes that can lead to liver cirrhosis, the main are:• Hepatitis B virus, hepatitis C and hepatitis D.• Excessive consumption of alcohol.• Nonalcoholic fatty liver: A conditioncommon in the general population,associated with diabetes and obesity.• Autoimmune Diseases: Autoimmunehepatitis and primary biliary cirrhosis.• Prolonged bile duct obstruction, suchas sclerosing cholangitis.• Lack of specific proteins or enzymes tometabolize different substances in theliver, as the deficiency of alpha 1-antitrypsin.• Certain diseases of the heart (heart failure).• Severe reaction to drugs or medications.• Prolonged exposure to toxic agents in the environment. -7-
    • SIGNS AND SYMPTOMSThe principle of cirrhosis is usually silent still very few specific symptoms. As damageaccumulates in the liver, may receive the following symptoms:• Loss of appetite.• Malaise.• Nausea and vomiting.• Weight loss.• Enlargement of the liver.• Jaundice or yellowing of the skin and whites ofthe eyes, due to the accumulation of blood whenthe liver is not able to remove either the bile.• Itching.• Ascites or fluid buildup in the abdomen.• Vomiting blood, broken veins (varices) in thelower esophagus.• Encephalopathy, or changes of consciousness,which can be subtle (confusion) or deep (coma).The diagnosis of cirrhosis can be unexpected. A person may present to the doctor withsymptoms of liver disease do not appear and after a physical examination and bloodtests to discover that tempt cirrhosis.TREATMENT The treatment for cirrhosis depends on the person suffering from cirrhosis, the time has gone on the disease and has suffered permanent damage to the liver. Sometimes the damage to the liver can be corrected by locating the specific cause of cirrhosis and is given appropriate treatment.• In the case of alcoholic cirrhosis, total abstinence and a balanced diet are importantparts of treatment.• In the case of cirrhosis secondary to viral hepatitis, drugs are used to enhanceimmune system response against the virus, such as interferon.• In cases of cirrhosis caused by autoimmune hepatitis, corticosteroids alone or incombination with azathioprine may be an effective treatment.• In cirrhotic patients with jaundice, treatment with supplemental fat soluble vitaminscan help.• In the case of Wilsons disease, it removes excessive amounts of copper in the bodythrough medication. -8-
    • • In hemochromatosis, removing excess iron by phlebotomy (blood removal).• Many types of cirrhosis requiring liver transplantation when advanced liver failure.WHAT ARE THE COMPLICATIONS OF CIRRHOSIS?Complications of cirrhosis include ascites, hepatic encephalopathy and bleeding fromruptured esophageal varices.• Ascites is treated by reducing salt intake plus administration of diuretics. In somecases it is necessary to direct disposal of large amounts of fluid in the abdomenthrough a catheter through the abdominal wall, also called paracentesis.• Treatment of hepatic coma or principle of coma (hepatic encephalopathy) requiresspecific drugs, reducing the intake of proteins and control of gastrointestinal bleeding.• Treatment of bleeding from esophageal varices include endoscopic ligation orsclerotherapy as (direct injection of a chemical that destroys the varix inside) and othertreatments such as medications that decrease the tendency to bleed, compression of ableeding varix through special inflatable balls and a procedure called transjugularintrahepatic protosystem shunt (TIPS).HOW I CAN I PREVENT CIRRHOSIS?• Do not drink to excess. Avoid alcoholic beverages. Alcohol destroys liver cells. Thedegree of regeneration of liver cells varies from person to person. Prior damage to theliver for unknown viruses or chemicals can affect the regeneration process.• Eat a balanced diet, maintain a healthy weight and do regular physical activity.• Seek medical help. Keep under medical care if you develop viral hepatitis until hisrecovery is assured.The liver is large, with large functional reserve, able to continue to play its vitalfunctions even if it is damaged. It also has the ability to repair itself to some degree.The cells that die can be replaced with new ones. If the cause of cirrhosis can beeliminated or controlled, the livers ability allows it to achieve some improvement andmay allow play a normal life. -9-
    • KORSAKOFF´S SYNDROMEKorsakoffs syndrome (also called Korsakoffsdementia, Korsakovs syndrome, Korsakoffspsychosis, or amnesic-confabulatory syndrome), is aneurological disorder caused by the lack of thiamine(vitamin B1) in the brain. Its onset is linked to chronicalcohol abuse and/or severe malnutrition. Thesyndrome is named after Sergei Korsakoff, theneuropsychiatrist who popularized the theory.CAUSESConditions resulting in the vitamin deficiency and its effects include chronic alcoholismand severe malnutrition. Alcoholism may be an indicator of poor nutrition, which inaddition to inflammation of the stomach lining, causes thiamine deficiency. Othercauses include dietary deficiencies, prolonged vomiting, eating disorders, or the effectsof chemotherapy. It can also occur in pregnant women who have a form of extrememorning sickness known as hyperemesis gravidarum. Mercury poisoning can also leadto Korsakoffs syndrome. It has also been caused by centipede (mukade) bites in Japan.There is no specific treatment because the previous thiamine deficiency producesirreversible damage to the medial thalamic nuclei and mammillary bodies. Mammillarybody atrophy may be visible on high-resolution MRI.SYMPTOMSThere are six major symptoms of Korsakoffs syndrome: anterograde amnesia. retrograde amnesia, severe memory loss. confabulation, that is, invented memories which are then taken as true due to gaps in memory sometimes associated with blackouts. meager content in conversation. lack of insight. apathy - the patients lose interest in things quickly and generally appear indifferent to change.These symptoms are caused by a deficiency of thiamine (vitamin B1), which is thoughtto cause damage to the medial thalamus and possibly to the mammillary bodies of thehypothalamus as well as generalized cerebral atrophy.When Wernickes encephalopathy accompanies Korsakoffs syndrome, thecombination is called the Wernicke-Korsakoff syndrome. Korsakoffs is a continuum of - 10 -
    • Wernickes encephalopathy, though a recognised episode of Wernickes is not alwaysobvious.Korsakoffs involves neuronal loss, that is, damage to neurons; gliosis which is a resultof damage to supporting cells of the central nervous system; and hemorrhage orbleeding in mammillary bodies. Damage to the dorsomedial nucleus or anterior groupof the thalamus (limbic-specific nuclei) is also associated with this disorder.SIGNS Apathy. Ataxia. Coma. Confabulation. Paralysis of muscles controlling the eye. Retrograde and anterograde amnesia. Tremor. Anosognosia - Lack of insight to or awareness of the condition.TREATMENTIt was once assumed that anyone suffering from Korsakoffs syndrome wouldeventually need full time care. This is still often the case, but rehabilitation can helpregain some, often limited, level of independence. Treatment involves thereplacement or supplementation of thiamine by intravenous (IV) or intramuscular (IM)injection, together with proper nutrition and hydration. However, the amnesia andbrain damage caused by the disease does not always respond to thiamine replacementtherapy. In some cases, drug therapy is recommended. If treatment is successful,improvement will become apparent within two years although recovery is slow andoften incomplete.PREVENTIONThe most effective method of preventing Korsakoffs syndrome is to avoid Bvitamin/thiamine deficiency. In Western nations, the most common causes of such adeficiency are alcoholism and weight disorders. In the U.S., government mandates toadding thiamine to alcoholic beverages have been blocked for this reason and also bypolitical groups asserting that such supplementation would encourage alcohol use. - 11 -