This document discusses the effects of alcohol on the gastrointestinal tract. It begins with an outline of the topics to be covered, including the types and patterns of alcohol consumption, effects on motility, mucosa, acid secretion, bactericidal action, risk of malignancy, and effects on the liver and pancreas. It then provides definitions for terms like alcohol use disorders. The document discusses screening tools for alcohol use disorders, management of alcohol withdrawal syndrome, and medical management of alcohol use disorder in patients with alcoholic liver disease. It concludes with recommendations for diagnostic tests in evaluating and managing alcoholic liver disease.
The document provides an overview of the European Association for the Study of the Liver (EASL) clinical practice guidelines for the management of alcohol-related liver disease (ALD). It discusses key topics such as the public health impact of alcohol, definitions and screening for alcohol use disorder, diagnostic tests and management approaches for different stages of ALD, and recommendations for treatment. The guidelines are based on an adapted GRADE system for grading evidence and provide evidence-based recommendations to standardize and improve care for patients with ALD.
Alcohol, or ethanol, is highly lipid soluble and is rapidly absorbed from the stomach and small intestine. It is metabolized in the liver by alcohol dehydrogenase and aldehyde dehydrogenase. Chronic alcohol abuse can cause damage to multiple organ systems like the liver, heart, pancreas and brain. Risk factors for alcoholism include genetics, family history of alcohol use, early initiation of drinking, frequent heavy drinking, mental health conditions, and trauma history. Alcohol tolerance refers to adaptations in the brain and liver that result in requiring more alcohol to produce the same effects. Metabolic tolerance involves activation of liver enzymes while functional tolerance impacts brain function.
The guidelines provide three key recommendations regarding public health aspects of alcohol-related liver disease (ALD):
1. Excess alcohol consumption should be addressed using pricing-based policies and regulation of availability to reduce population risk.
2. Advertising and marketing of alcohol should be banned to decrease consumption.
3. Primary care facilities for managing alcohol use disorder must be widely available and screening for harmful drinking and ALD should be performed in high-risk groups followed by brief intervention and multidisciplinary treatment.
This document discusses the dynamics and abuse of alcohol. It summarizes that alcohol abuse and dependence are chronic diseases influenced by genetic and environmental factors. It then discusses the pharmacokinetics of alcohol metabolism and various medical issues associated with alcoholism, including withdrawal symptoms, effects on organ systems like the liver and heart, cancers, and other conditions.
Chronic excessive alcohol consumption is a major cause of liver disease and cirrhosis mortality. The progression of alcoholic liver disease includes fatty liver in over 90% of heavy drinkers, alcoholic hepatitis in a smaller percentage, and cirrhosis with a dismal prognosis. Only 10-20% of alcoholics develop alcoholic hepatitis due to complex interactions between drinking patterns, diet, obesity, and gender. Women are more susceptible than men.
Alcoholic liver disease is caused by excessive alcohol consumption over a long period of time. It begins with fatty liver and can progress to alcoholic hepatitis, fibrosis, and cirrhosis of the liver if drinking continues. The amount and duration of alcohol intake needed to cause liver damage is 60-80 grams per day for over 20 years in men and half that amount in women. Treatment involves complete alcohol abstinence, nutritional supplementation, and medications like prednisolone and vitamins to support liver healing.
This document summarizes alcoholic liver disease, including alcoholic hepatitis, fibrosis, and cirrhosis. It discusses the incidence and risk factors of alcoholic liver disease globally. Screening tools for alcohol misuse and the management of alcohol withdrawal syndrome are presented. The diagnosis, evaluation of severity, and treatment of alcoholic hepatitis are covered in detail. Non-invasive tests and the role of liver biopsy are also summarized.
The document provides an overview of the European Association for the Study of the Liver (EASL) clinical practice guidelines for the management of alcohol-related liver disease (ALD). It discusses key topics such as the public health impact of alcohol, definitions and screening for alcohol use disorder, diagnostic tests and management approaches for different stages of ALD, and recommendations for treatment. The guidelines are based on an adapted GRADE system for grading evidence and provide evidence-based recommendations to standardize and improve care for patients with ALD.
Alcohol, or ethanol, is highly lipid soluble and is rapidly absorbed from the stomach and small intestine. It is metabolized in the liver by alcohol dehydrogenase and aldehyde dehydrogenase. Chronic alcohol abuse can cause damage to multiple organ systems like the liver, heart, pancreas and brain. Risk factors for alcoholism include genetics, family history of alcohol use, early initiation of drinking, frequent heavy drinking, mental health conditions, and trauma history. Alcohol tolerance refers to adaptations in the brain and liver that result in requiring more alcohol to produce the same effects. Metabolic tolerance involves activation of liver enzymes while functional tolerance impacts brain function.
The guidelines provide three key recommendations regarding public health aspects of alcohol-related liver disease (ALD):
1. Excess alcohol consumption should be addressed using pricing-based policies and regulation of availability to reduce population risk.
2. Advertising and marketing of alcohol should be banned to decrease consumption.
3. Primary care facilities for managing alcohol use disorder must be widely available and screening for harmful drinking and ALD should be performed in high-risk groups followed by brief intervention and multidisciplinary treatment.
This document discusses the dynamics and abuse of alcohol. It summarizes that alcohol abuse and dependence are chronic diseases influenced by genetic and environmental factors. It then discusses the pharmacokinetics of alcohol metabolism and various medical issues associated with alcoholism, including withdrawal symptoms, effects on organ systems like the liver and heart, cancers, and other conditions.
Chronic excessive alcohol consumption is a major cause of liver disease and cirrhosis mortality. The progression of alcoholic liver disease includes fatty liver in over 90% of heavy drinkers, alcoholic hepatitis in a smaller percentage, and cirrhosis with a dismal prognosis. Only 10-20% of alcoholics develop alcoholic hepatitis due to complex interactions between drinking patterns, diet, obesity, and gender. Women are more susceptible than men.
Alcoholic liver disease is caused by excessive alcohol consumption over a long period of time. It begins with fatty liver and can progress to alcoholic hepatitis, fibrosis, and cirrhosis of the liver if drinking continues. The amount and duration of alcohol intake needed to cause liver damage is 60-80 grams per day for over 20 years in men and half that amount in women. Treatment involves complete alcohol abstinence, nutritional supplementation, and medications like prednisolone and vitamins to support liver healing.
This document summarizes alcoholic liver disease, including alcoholic hepatitis, fibrosis, and cirrhosis. It discusses the incidence and risk factors of alcoholic liver disease globally. Screening tools for alcohol misuse and the management of alcohol withdrawal syndrome are presented. The diagnosis, evaluation of severity, and treatment of alcoholic hepatitis are covered in detail. Non-invasive tests and the role of liver biopsy are also summarized.
This document provides information on alcoholic liver disease, including its incidence, progression, risk factors, pathogenesis, clinical findings, diagnostic testing, differential diagnosis, prognosis, and screening tools. Some key points:
- Heavy alcohol use can lead to fatty liver in 90-100% of people within 10 years, while only 10-35% will develop alcoholic steatohepatitis and 8-20% will progress to cirrhosis.
- Risk is increased by factors like younger age of onset, female sex, certain ethnicities, coinfection with hepatitis B or C, iron overload, and obesity.
- Alcohol causes liver injury through mechanisms like centrilobular hypoxia, neutrophil infiltration, antigen formation,
ALCOHOLIC HEPATITIS AND ALCOHOL USE DISORDER 2019 AASLD (1).pptxDrdeepak17
This document provides guidance on diagnosing and treating alcoholic hepatitis (AH) and alcohol use disorder (AUD). It recommends screening all patients for alcohol use using validated tools. Patients engaging in hazardous drinking or with AUD should be offered brief intervention, medication, or referral to treatment. Prednisolone treatment may improve outcomes for severe AH, while nutrition and abstinence are also important. Liver transplantation should be considered for decompensated alcohol-associated cirrhosis.
Chronic and excessive alcohol consumption can lead to a spectrum of alcoholic liver disease (ALD) ranging from fatty liver to cirrhosis. The risk and severity increases with the amount of alcohol consumed daily over many years. Diagnosis involves documenting a history of heavy drinking and liver-related abnormalities. Treatment focuses on abstinence to prevent progression of disease. Corticosteroids may help severe alcoholic hepatitis while liver transplantation is an option for end-stage cirrhosis. Long-term management involves screening for complications and lifestyle changes to support abstinence and liver health.
Alcohol-ADVI (1).pptx. Ethanol is rapidly oxidised by the body to carbon diox...Mona487538
ethanol effects on health. Symptoms of exposure to ethanol may include irritation to the eyes, skin and nose, drowsiness and headache. Other symptoms may include stupor, nausea, mental excitement or depression, vomiting, flushing and coma. Exposure to high concentrations of ethanol vapours may cause irritation of the eyes, skin and respiratory tract, loss of coordination (ataxia), sleepiness, narcosis (stupor or unconsciousness), impaired perception and lack of coordination. It can also cause lowered inhibitions, dizziness, shallow respiration, unconsciousness and death. Ethanol is harmful by ingestion, inhalation or by skin absorption.
Repeated contact can dry the skin resulting in the skin cracking, peeling and itching.
Ethanol can depress the central nervous system, the eyes and upper respiratory tract (nose and throat). Ethanol can cause irritation, headache, fatigue and loss of concentration.
Consumption of ethanol during pregnancy may affect the unborn child, resulting in spontaneous abortion, developmental problems, or birth defects. This is known as 'foetal alcohol syndrome'. Chronic ingestion of ethanol may cause liver cirrhosis, affect the nervous system and affect the glands in humans.
Ethanol may cause mutations (genetic changes).
Ethanol is rapidly oxidised by the body to carbon dioxide and water, with no cumulative effect. Concentrations below 1000 parts per million (ppm) usually produce no signs of intoxication.
This document discusses alcohol withdrawal syndrome. It begins by outlining the objectives of understanding how alcohol works in the body and causes dependence, why withdrawal occurs when use is reduced or stopped, how patients may present, and how to manage withdrawal. It then provides details on the pharmacology of alcohol, the diagnostic criteria for withdrawal, management using medications like benzodiazepines and vitamin supplements, and concluding with the importance of anticipating and preventing severe withdrawal symptoms.
Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis or cirrhosis.
This document summarizes a systematic review of 17 cases of cardiovascular events associated with energy drink consumption. Most cases involved teenagers and young adults consuming energy drinks in large quantities over a short period of time, often mixed with alcohol. While causality cannot be determined, the review found that heavy energy drink consumption was implicated in several cases. The document calls for further research to better understand risks, as well as improved labeling and warnings regarding energy drink consumption among vulnerable groups.
This document summarizes a systematic review of 17 cases of cardiovascular events associated with energy drink consumption. Most cases involved teenagers and young adults consuming energy drinks in large quantities over a short period of time, often mixed with alcohol. While causality cannot be determined, the review found that heavy energy drink consumption was implicated in several cases. The document calls for further research to better understand risks, as well as improved labeling and warnings regarding energy drink consumption among vulnerable groups.
The rapid increase in energy drink (ED) consumption has stimulated growing public concern with adverse events related to ED consumption.
The US Substance Abuse Services and Mental Health Administration has reported that over a 4-year period from 2007 to 2011, emergency department visits related to EDs more than doubled to >20,000 visits annually.
Most of the adverse effects and toxicities associated with EDs have been attributed to the high caffeine content of EDs.
Alcoholism is defined as harmful and uncontrollable alcohol consumption that can cause disorders like depression and anxiety. Long-term alcoholism affects the body's metabolism, organs, and nutrition levels. It has genetic and environmental causes, and is more common in males. Symptoms include intoxication, withdrawal, tolerance, and medical conditions. Treatment aims to promote abstinence through detoxification, counseling, social support, and medications like disulfiram or naltrexone.
Alcohol use disorder refers to a pattern of excessive drinking that results in adverse health and social consequences. Alcohol abuse is when a person drinks alcohol to help change how they feel and gets complaints about their drinking. Alcohol dependence involves craving alcohol, impaired control over drinking, withdrawal symptoms when stopping, and needing more alcohol to feel its effects. Heavy or binge drinking can damage one's health by affecting the gastrointestinal, central nervous, and cardiovascular systems and increase risks of injuries, violence and accidents.
Alcohol
ALCOHOL INTAKE
Rakkan Fagirah
Alcohol Beverages
Beer: is a mild intoxicant brewed by a mixture of grains and usually has 3-6% alcohol by volume.
Ales and Malt Liquor: They are also made by grains and similar to beer usually contains 6-8% per volume
Wines: It is made by fermenting the juice of fruits. And it has 9-14% per volume.
Hard Liquor: it is made by distilling fermented or brewed grains or other plants. Usually contains about 35-50%
Concentration of Alcohol
The concentration of Alcohol is indicated by it is Proof Value: which amounts to two times the percentage concentration. So if the beverage has an 80 proof, then it contains 40% alcohol by volume. So two ounces of an 80 proof Vodka it contains 80% alcohol.
Standard vs Actual Servings
The term one drink or a standard drink refers to a drink with an amount of 0.6 ounce of alcohol.
12-ounce bottle of beer.
8-ounce Malt liquor
5-ounce glass of a wine.
1.5-ounce shot of liquor.
Even though this is the standard servings size people tend to drink way more than that.
Calories content
Alcohol provides 7 calories per gram.
In a typical one drink there is 100-120 calories.
In regular beer there is 150 calories.
Light beer contains 100 calories.
5-ounce glass of wine contains 100 calories
3-ounce of Margarita contains 157 calories
6-Ounce of rum and coke contains about 180 calories
Absorption of Alcohol
When Alcohol ingested 20% of it is absorbed from the stomach.
75% is absorbed through the stomach and the upper part of the small Intestine
The rest is absorbed from the GI (Gastrointestinal)
The rate of absorption is affected by various factors:
Carbonation increases the rate.
Artificial sweeteners have the same affect
Food slows the rate absorption
Drinking high concentrated drinks also slows the rate of absorption
Alcohol Metabolism
Alcohol Metabolizes, transfers into usable and waste parts mainly in the liver.
Small amount of alcohol is metabolized in the stomach
2-10% of the alcohol excreted unchanged by the lungs, kidneys, and sweat glands.
Excreted alcohol causes the telltale to smell on a drinker’s breath and it is the basis analysis of a person’s breath and urine to tests the alcohol levels.
Blood Alcohol Concentration (BAC)
BAC: is the ratio of alcohol in a person’s blood by weight, or the percentage of alcohol measured in deciliter of blood.
It is affected by metabolizes 0.3 ounce of alcohol per hour.
The rate of alcohol metabolism is determined by genetic factors
and drinking behavior.
Although the rate of absorption can be affected by many factors the rate of Metabolism cannot be slowed.
A person can lower the rate of the BAC only by drinking over long period of time.
How to calculate BAC
https://www.youtube.com/watch?v=1C3TFjAGMVI
ALCOHOL AND HEALTH
Immediate and Long term affects
Mohammed Bantalal
Immediate affects
Low concentration:
It happens at a BAC of 0.03-0.05%:
Light Headedness
Relaxation
Release of inhib.
1) Alcohol-related liver disease (ARLD) places a significant burden on healthcare systems. Patients with ARLD often have multiple hospital admissions before death from liver failure or complications.
2) Early identification of alcohol misuse and intervention can help reduce further liver damage if patients change their drinking behavior. However, screening and treatment of ARLD remains suboptimal in many hospitals.
3) Prognosis in ARLD depends on severity of liver disease and presence of complications. Scores like MELD and CLIF-SOFA can help predict outcomes but assessment of social factors is also important.
The document discusses alcohol misuse and dependence. It defines various categories of alcohol use from moderate drinking to alcohol abuse and dependence. It describes screening tools like the CAGE questionnaire and discusses the medical, psychological, and social consequences of chronic alcohol misuse including withdrawal symptoms, medical complications affecting multiple organ systems, increased risk of accidents and injuries, and psychiatric issues like depression and anxiety. Management involves referral for treatment, brief counseling, and FDA-approved medications like disulfiram, naltrexone, and acamprosate combined with behavioral support.
This document discusses alcohol misuse and dependence. It defines various categories of alcohol use from moderate to risky, hazardous, and harmful drinking. It describes the criteria for alcohol abuse and dependence according to diagnostic manuals. It also discusses screening tools like the CAGE questionnaire and AUDIT test. The health effects of chronic alcohol misuse are outlined, as well as psychiatric and brain consequences. Approaches to diagnosis, management, and prevention are summarized.
This document provides an overview of alcohol and its effects. It defines alcohol and alcoholism, and discusses the causes and development of alcoholism. It describes the physical, psychiatric, and social complications of alcoholism in both the short and long term. It outlines the general, medical, pharmacological, and nursing management of alcoholism, as well as important goals and prevention strategies. Health promotion approaches are also discussed. The document is submitted for a nursing program and contains 22 referenced pages on the topic.
This document discusses a case of alcoholic liver disease being investigated by Dr. N. Gautam. It provides background information on liver anatomy, alcohol metabolism, and the pathophysiology and clinical presentations of alcoholic liver disease. It describes the typical laboratory investigations performed for ALD including liver enzymes, bilirubin, proteins, and coagulation factors. The document then presents findings from a 45-year-old chronic alcoholic male patient presenting with abdominal pain, jaundice and altered sensorium, with laboratory results consistent with severe alcoholic hepatitis.
Renal function tests are important for identifying, diagnosing, monitoring renal dysfunction and disease. Key tests include urinalysis to detect abnormalities in urine appearance, composition and sediments. Glomerular filtration rate (GFR) is a key measure of renal function and can be estimated using creatinine clearance from plasma and urine creatinine levels or formulas. Other tests evaluate tubular function like handling of electrolytes, acids, proteins and determine if renal issues are pre-renal or intrinsic to the kidneys. Together these tests provide vital information about renal health and disease.
This document discusses hypoglycemic agents or anti-diabetic drugs used to treat diabetes mellitus. It describes diabetes as a metabolic syndrome caused by insulin deficiency and excess glucagon that can lead to acute manifestations like hyperglycemia and chronic complications affecting small blood vessels and arteries. It outlines the different types of diabetes and treatments including insulin therapies using rapid, short, intermediate and long-acting insulins. It also discusses oral hypoglycemic drugs for type 2 diabetes including sulfonylureas, biguanides, glitazones and alpha-glucosidase inhibitors providing details on their mechanisms, uses, and potential toxicities in treatment.
This document provides information on alcoholic liver disease, including its incidence, progression, risk factors, pathogenesis, clinical findings, diagnostic testing, differential diagnosis, prognosis, and screening tools. Some key points:
- Heavy alcohol use can lead to fatty liver in 90-100% of people within 10 years, while only 10-35% will develop alcoholic steatohepatitis and 8-20% will progress to cirrhosis.
- Risk is increased by factors like younger age of onset, female sex, certain ethnicities, coinfection with hepatitis B or C, iron overload, and obesity.
- Alcohol causes liver injury through mechanisms like centrilobular hypoxia, neutrophil infiltration, antigen formation,
ALCOHOLIC HEPATITIS AND ALCOHOL USE DISORDER 2019 AASLD (1).pptxDrdeepak17
This document provides guidance on diagnosing and treating alcoholic hepatitis (AH) and alcohol use disorder (AUD). It recommends screening all patients for alcohol use using validated tools. Patients engaging in hazardous drinking or with AUD should be offered brief intervention, medication, or referral to treatment. Prednisolone treatment may improve outcomes for severe AH, while nutrition and abstinence are also important. Liver transplantation should be considered for decompensated alcohol-associated cirrhosis.
Chronic and excessive alcohol consumption can lead to a spectrum of alcoholic liver disease (ALD) ranging from fatty liver to cirrhosis. The risk and severity increases with the amount of alcohol consumed daily over many years. Diagnosis involves documenting a history of heavy drinking and liver-related abnormalities. Treatment focuses on abstinence to prevent progression of disease. Corticosteroids may help severe alcoholic hepatitis while liver transplantation is an option for end-stage cirrhosis. Long-term management involves screening for complications and lifestyle changes to support abstinence and liver health.
Alcohol-ADVI (1).pptx. Ethanol is rapidly oxidised by the body to carbon diox...Mona487538
ethanol effects on health. Symptoms of exposure to ethanol may include irritation to the eyes, skin and nose, drowsiness and headache. Other symptoms may include stupor, nausea, mental excitement or depression, vomiting, flushing and coma. Exposure to high concentrations of ethanol vapours may cause irritation of the eyes, skin and respiratory tract, loss of coordination (ataxia), sleepiness, narcosis (stupor or unconsciousness), impaired perception and lack of coordination. It can also cause lowered inhibitions, dizziness, shallow respiration, unconsciousness and death. Ethanol is harmful by ingestion, inhalation or by skin absorption.
Repeated contact can dry the skin resulting in the skin cracking, peeling and itching.
Ethanol can depress the central nervous system, the eyes and upper respiratory tract (nose and throat). Ethanol can cause irritation, headache, fatigue and loss of concentration.
Consumption of ethanol during pregnancy may affect the unborn child, resulting in spontaneous abortion, developmental problems, or birth defects. This is known as 'foetal alcohol syndrome'. Chronic ingestion of ethanol may cause liver cirrhosis, affect the nervous system and affect the glands in humans.
Ethanol may cause mutations (genetic changes).
Ethanol is rapidly oxidised by the body to carbon dioxide and water, with no cumulative effect. Concentrations below 1000 parts per million (ppm) usually produce no signs of intoxication.
This document discusses alcohol withdrawal syndrome. It begins by outlining the objectives of understanding how alcohol works in the body and causes dependence, why withdrawal occurs when use is reduced or stopped, how patients may present, and how to manage withdrawal. It then provides details on the pharmacology of alcohol, the diagnostic criteria for withdrawal, management using medications like benzodiazepines and vitamin supplements, and concluding with the importance of anticipating and preventing severe withdrawal symptoms.
Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis or cirrhosis.
This document summarizes a systematic review of 17 cases of cardiovascular events associated with energy drink consumption. Most cases involved teenagers and young adults consuming energy drinks in large quantities over a short period of time, often mixed with alcohol. While causality cannot be determined, the review found that heavy energy drink consumption was implicated in several cases. The document calls for further research to better understand risks, as well as improved labeling and warnings regarding energy drink consumption among vulnerable groups.
This document summarizes a systematic review of 17 cases of cardiovascular events associated with energy drink consumption. Most cases involved teenagers and young adults consuming energy drinks in large quantities over a short period of time, often mixed with alcohol. While causality cannot be determined, the review found that heavy energy drink consumption was implicated in several cases. The document calls for further research to better understand risks, as well as improved labeling and warnings regarding energy drink consumption among vulnerable groups.
The rapid increase in energy drink (ED) consumption has stimulated growing public concern with adverse events related to ED consumption.
The US Substance Abuse Services and Mental Health Administration has reported that over a 4-year period from 2007 to 2011, emergency department visits related to EDs more than doubled to >20,000 visits annually.
Most of the adverse effects and toxicities associated with EDs have been attributed to the high caffeine content of EDs.
Alcoholism is defined as harmful and uncontrollable alcohol consumption that can cause disorders like depression and anxiety. Long-term alcoholism affects the body's metabolism, organs, and nutrition levels. It has genetic and environmental causes, and is more common in males. Symptoms include intoxication, withdrawal, tolerance, and medical conditions. Treatment aims to promote abstinence through detoxification, counseling, social support, and medications like disulfiram or naltrexone.
Alcohol use disorder refers to a pattern of excessive drinking that results in adverse health and social consequences. Alcohol abuse is when a person drinks alcohol to help change how they feel and gets complaints about their drinking. Alcohol dependence involves craving alcohol, impaired control over drinking, withdrawal symptoms when stopping, and needing more alcohol to feel its effects. Heavy or binge drinking can damage one's health by affecting the gastrointestinal, central nervous, and cardiovascular systems and increase risks of injuries, violence and accidents.
Alcohol
ALCOHOL INTAKE
Rakkan Fagirah
Alcohol Beverages
Beer: is a mild intoxicant brewed by a mixture of grains and usually has 3-6% alcohol by volume.
Ales and Malt Liquor: They are also made by grains and similar to beer usually contains 6-8% per volume
Wines: It is made by fermenting the juice of fruits. And it has 9-14% per volume.
Hard Liquor: it is made by distilling fermented or brewed grains or other plants. Usually contains about 35-50%
Concentration of Alcohol
The concentration of Alcohol is indicated by it is Proof Value: which amounts to two times the percentage concentration. So if the beverage has an 80 proof, then it contains 40% alcohol by volume. So two ounces of an 80 proof Vodka it contains 80% alcohol.
Standard vs Actual Servings
The term one drink or a standard drink refers to a drink with an amount of 0.6 ounce of alcohol.
12-ounce bottle of beer.
8-ounce Malt liquor
5-ounce glass of a wine.
1.5-ounce shot of liquor.
Even though this is the standard servings size people tend to drink way more than that.
Calories content
Alcohol provides 7 calories per gram.
In a typical one drink there is 100-120 calories.
In regular beer there is 150 calories.
Light beer contains 100 calories.
5-ounce glass of wine contains 100 calories
3-ounce of Margarita contains 157 calories
6-Ounce of rum and coke contains about 180 calories
Absorption of Alcohol
When Alcohol ingested 20% of it is absorbed from the stomach.
75% is absorbed through the stomach and the upper part of the small Intestine
The rest is absorbed from the GI (Gastrointestinal)
The rate of absorption is affected by various factors:
Carbonation increases the rate.
Artificial sweeteners have the same affect
Food slows the rate absorption
Drinking high concentrated drinks also slows the rate of absorption
Alcohol Metabolism
Alcohol Metabolizes, transfers into usable and waste parts mainly in the liver.
Small amount of alcohol is metabolized in the stomach
2-10% of the alcohol excreted unchanged by the lungs, kidneys, and sweat glands.
Excreted alcohol causes the telltale to smell on a drinker’s breath and it is the basis analysis of a person’s breath and urine to tests the alcohol levels.
Blood Alcohol Concentration (BAC)
BAC: is the ratio of alcohol in a person’s blood by weight, or the percentage of alcohol measured in deciliter of blood.
It is affected by metabolizes 0.3 ounce of alcohol per hour.
The rate of alcohol metabolism is determined by genetic factors
and drinking behavior.
Although the rate of absorption can be affected by many factors the rate of Metabolism cannot be slowed.
A person can lower the rate of the BAC only by drinking over long period of time.
How to calculate BAC
https://www.youtube.com/watch?v=1C3TFjAGMVI
ALCOHOL AND HEALTH
Immediate and Long term affects
Mohammed Bantalal
Immediate affects
Low concentration:
It happens at a BAC of 0.03-0.05%:
Light Headedness
Relaxation
Release of inhib.
1) Alcohol-related liver disease (ARLD) places a significant burden on healthcare systems. Patients with ARLD often have multiple hospital admissions before death from liver failure or complications.
2) Early identification of alcohol misuse and intervention can help reduce further liver damage if patients change their drinking behavior. However, screening and treatment of ARLD remains suboptimal in many hospitals.
3) Prognosis in ARLD depends on severity of liver disease and presence of complications. Scores like MELD and CLIF-SOFA can help predict outcomes but assessment of social factors is also important.
The document discusses alcohol misuse and dependence. It defines various categories of alcohol use from moderate drinking to alcohol abuse and dependence. It describes screening tools like the CAGE questionnaire and discusses the medical, psychological, and social consequences of chronic alcohol misuse including withdrawal symptoms, medical complications affecting multiple organ systems, increased risk of accidents and injuries, and psychiatric issues like depression and anxiety. Management involves referral for treatment, brief counseling, and FDA-approved medications like disulfiram, naltrexone, and acamprosate combined with behavioral support.
This document discusses alcohol misuse and dependence. It defines various categories of alcohol use from moderate to risky, hazardous, and harmful drinking. It describes the criteria for alcohol abuse and dependence according to diagnostic manuals. It also discusses screening tools like the CAGE questionnaire and AUDIT test. The health effects of chronic alcohol misuse are outlined, as well as psychiatric and brain consequences. Approaches to diagnosis, management, and prevention are summarized.
This document provides an overview of alcohol and its effects. It defines alcohol and alcoholism, and discusses the causes and development of alcoholism. It describes the physical, psychiatric, and social complications of alcoholism in both the short and long term. It outlines the general, medical, pharmacological, and nursing management of alcoholism, as well as important goals and prevention strategies. Health promotion approaches are also discussed. The document is submitted for a nursing program and contains 22 referenced pages on the topic.
This document discusses a case of alcoholic liver disease being investigated by Dr. N. Gautam. It provides background information on liver anatomy, alcohol metabolism, and the pathophysiology and clinical presentations of alcoholic liver disease. It describes the typical laboratory investigations performed for ALD including liver enzymes, bilirubin, proteins, and coagulation factors. The document then presents findings from a 45-year-old chronic alcoholic male patient presenting with abdominal pain, jaundice and altered sensorium, with laboratory results consistent with severe alcoholic hepatitis.
Renal function tests are important for identifying, diagnosing, monitoring renal dysfunction and disease. Key tests include urinalysis to detect abnormalities in urine appearance, composition and sediments. Glomerular filtration rate (GFR) is a key measure of renal function and can be estimated using creatinine clearance from plasma and urine creatinine levels or formulas. Other tests evaluate tubular function like handling of electrolytes, acids, proteins and determine if renal issues are pre-renal or intrinsic to the kidneys. Together these tests provide vital information about renal health and disease.
This document discusses hypoglycemic agents or anti-diabetic drugs used to treat diabetes mellitus. It describes diabetes as a metabolic syndrome caused by insulin deficiency and excess glucagon that can lead to acute manifestations like hyperglycemia and chronic complications affecting small blood vessels and arteries. It outlines the different types of diabetes and treatments including insulin therapies using rapid, short, intermediate and long-acting insulins. It also discusses oral hypoglycemic drugs for type 2 diabetes including sulfonylureas, biguanides, glitazones and alpha-glucosidase inhibitors providing details on their mechanisms, uses, and potential toxicities in treatment.
Echocardiography uses ultrasound to generate images of cardiac anatomy and function. The echocardiogram machine includes a transducer probe that transmits and receives ultrasound waves, and a display monitor. Different echocardiography modes exist, including M-mode for measuring dimensions, 2D/3D for morphology, and various Doppler modes for assessing blood flow velocity and direction. Trans-esophageal echocardiography uses a probe attached to an endoscope to obtain high resolution internal images of the heart. Echocardiography is used to evaluate conditions like thrombi, aneurysms, valves, and septal defects.
DISEASES OF THE THYROID GLAND NOVEMBER 2018.pptxKemi Adaramola
This document discusses diseases of the thyroid gland. It begins by describing the anatomy and physiology of the thyroid, including its location in the neck, histological structure, embryological development, and hormone production process. It then discusses the main thyroid diseases - thyrotoxicosis (Graves' disease, toxic nodular goiter, etc.) and hypothyroidism. For each condition, it outlines the etiology, clinical features, investigations, and treatment approaches. It also describes thyroid storm, a medical emergency representing severe thyrotoxicosis, and myxedema coma, a severe form of hypothyroidism.
This document discusses the management of diabetes mellitus in children beyond typical norms. It begins with an introduction to diabetes and classifications of types of diabetes including type 1, type 2, and maturity onset diabetes of the young (MODY). It then discusses epidemiology and the local experience with childhood diabetes at Ekiti State University Teaching Hospital. The remainder of the document focuses on treatment and management of type 1 diabetes in children, including insulin regimens, therapeutic goals, and sick day rules. It also briefly discusses type 2 diabetes in children and the differences between type 1 and type 2 diabetes.
Defibrillation is a process that delivers an electric shock to the heart to stop an irregular heartbeat and restore normal rhythm. It is the only effective treatment for cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia. Early defibrillation is critical, as survival rates decrease by 10% each minute without treatment. Different types of defibrillators include automated external defibrillators and implantable cardioverter defibrillators. Key factors that influence defibrillation success include transthoracic impedance, electrode placement and position, and shock waveform and energy level delivered.
PULMONARYHYPERTENSION IN HEART FAILURE.pptxKemi Adaramola
This patient presented with bilateral leg swelling, abdominal swelling, facial swelling, and exertional dyspnea over the past 2 years. She has a history of recurrent productive cough as a child treated with antibiotics. On examination she had clubbing, leg swelling up to the knees, enlarged liver, ascites, and signs of right heart failure. Investigations showed features consistent with constrictive pericarditis and severe pulmonary hypertension likely due to tuberculous pericarditis in the past. She was treated unsuccessfully for heart failure and later developed venous thrombosis, remaining in the hospital for over 50 days before leaving against medical advice due to financial constraints.
This document outlines the causes, clinical features, diagnosis, and management of an Addisonian crisis, which is a life-threatening adrenal insufficiency emergency. It may be triggered by stress, infection, trauma, or withdrawal from steroids. Symptoms include nausea, vomiting, abdominal pain, hypotension, and electrolyte imbalances. Treatment involves intravenous hydrocortisone, fluids, glucose, and identifying and treating any precipitating causes. Long term management consists of glucocorticoid and mineralocorticoid replacement therapy and patient education.
This document outlines an introduction to pulmonary hypertension including its epidemiology, etiology, pathogenesis, clinical features, treatment, and future directions. It defines pulmonary hypertension and notes the most common causes are lung diseases like COPD. In Nigeria, common causes include COPD, tuberculosis, connective tissue diseases, and sickle cell disease. The pathogenesis involves remodeling of the pulmonary vasculature from factors like endothelial dysfunction and an imbalance of vasoconstrictors and vasodilators. Over time, this can lead to right heart failure if the right ventricle can no longer compensate for the increased resistance.
This document discusses cardiovascular disease risk factors. It begins by introducing the topic and outlines the sections. The introduction notes that CVD is a leading cause of death worldwide. The epidemiology section describes the prevalence of CVD globally and in certain regions. The pathophysiology section explains the development of atherosclerosis. The traditional risk factors section lists established risks like hypertension, diabetes, and smoking. The document focuses on emerging risk factors, describing biomarkers like lipoprotein(a), apolipoprotein B, and homocysteine that can help identify risk beyond traditional factors. It discusses the evidence supporting these novel factors and their clinical implications.
This document provides an overview of the management of ascites. It discusses the epidemiology, etiology, pathophysiology, evaluation, treatment, and complications of ascites. Ascites is most often caused by portal hypertension from liver cirrhosis. Other causes include malignancy, infection, heart failure, and nephrotic syndrome. Evaluation involves diagnostic paracentesis and ascitic fluid analysis. Treatment depends on the underlying cause but typically involves dietary sodium restriction and diuretic medication. Complications include spontaneous bacterial peritonitis.
Bronchiectasis, lung abscess, and empyema are chronic lung infections that can result from complications of pneumonia. They often occur in people with underlying lung disease or immune disorders. Key features include recurrent chest infections, coughing, sputum production, and life-threatening complications like respiratory failure. Treatment involves identifying and addressing the underlying cause, airway clearance techniques, long-term antibiotics, and surgery in some cases.
This document discusses impetigo, a common bacterial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes. It presents in two forms: non-bullous and bullous. Symptoms include lesions on the face or limbs that may crust over. While usually mild, impetigo can develop into ecthyma if untreated. Treatment involves cleaning the skin, removing crusts, and using topical or oral antibiotics like mupirocin, retapamulin, cloxacillin, or erythromycin. Complications may include regional lymphadenopathy or ecthyma, a deeper skin ulceration.
This document discusses acute leukaemias in adults, including acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). It covers the incidence, risk factors, pathogenesis, clinical features, classification, prognostic factors, treatment for induction and post-remission, and supportive care for AML and ALL. The prognosis for ALL in adults remains poor despite high initial response rates to therapy. Improved supportive care and bone marrow transplantation are utilized while awaiting new, better therapies for these aggressive malignancies.
This document provides an overview of blood components therapy, including their indications and guidelines for use. It discusses the various components that can be derived from whole blood, such as packed red blood cells, platelets, fresh frozen plasma, cryoprecipitate, and granulocytes. Storage conditions, shelf lives, and therapeutic doses are provided. The main reasons for transfusion in Africa are described as childhood malaria, hemoglobinopathies, obstetric bleeding, trauma, and certain surgical procedures. Contraindications and risks of transfusion-transmitted infections are also covered. The document emphasizes considering alternatives to transfusion and whether benefits outweigh risks in each clinical situation.
This document provides an overview of haemoglobinopathies with an emphasis on sickle cell anaemia (SCA). It describes the complications and types of crises seen in SCA, how to identify them, and the modalities for treating various crises in the local environment. The introduction defines qualitative and quantitative haemoglobin abnormalities. It then outlines SCA pathogenesis, epidemiology, complications including vaso-occlusive crisis, management of crises through treatment of pain and infections, and prevention of sickle cell crises.
This document discusses Lassa fever, an endemic viral hemorrhagic fever found in parts of West Africa including Nigeria. It was first identified in 1969 after an outbreak infected and killed healthcare workers. The virus is transmitted from rodents to humans and can also spread between humans. Symptoms include fever, headache and bleeding. Diagnosis involves ELISA, virus isolation or PCR. Treatment is supportive, though the antiviral ribavirin may help if given early. Prevention focuses on rodent control, barrier nursing and safe medical practices. Nosocomial outbreaks remain a risk where infection control is poor. The document provides extensive details on the virus, epidemiology, transmission, clinical features, treatment and control of Lassa fever.
This document provides an overview of pituitary disorders, including:
- The pituitary gland regulates other endocrine glands and is regulated by the hypothalamus. It has anterior and posterior lobes.
- Anterior pituitary disorders include hyposecretion (hypopituitarism), hypersecretion (adenomas like prolactinomas and Cushing's disease), and sella enlargement.
- Causes of hypopituitarism include invasion, infarction, infiltration, injury, infections, immunologic issues, being iatrogenic, or being idiopathic. Symptom onset is gradual and follows a sequence of hormone deficiencies.
- Hyperfunctioning disorders include prolactinomas, acromegaly/
1. Stroke is defined as an acute brain attack caused by a disruption of blood flow, leading to neurological dysfunction lasting more than 24 hours.
2. Stroke is a leading cause of long-term disability worldwide and a major risk factor is hypertension. Diagnosis involves assessing symptoms, risk factors, and imaging of the brain.
3. There are two main types of stroke - ischemia caused by blockage of a blood vessel and hemorrhage caused by bleeding within the brain. Imaging is needed to distinguish between types and guide treatment.
Primary adrenal insufficiency, also known as Addison's disease, is caused by destruction or dysfunction of the adrenal cortex resulting in deficiencies of glucocorticoids and mineralocorticoids. Thomas Addison first described the clinical presentation in 1855. It most commonly presents with hyperpigmentation, dizziness, weakness, and weight loss. Diagnosis involves tests showing a lack of response to ACTH stimulation and electrolyte abnormalities. Treatment is lifelong glucocorticoid and mineralocorticoid hormone replacement to prevent adrenal crises.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
2. outline
• Introduction; alcohol, public health perspective
• Types & Pattern of alcohol consumption, quantity
• Safe level and toxicity; effect on motility, mucosa
effects, acid secretion, bactericidal action on H
pylori and other enteropathogens, promotion of
malignancy, effect on the liver and pancreas
• Managing alcohol abuse disorder
3. Terminologies
• Alcohol use disorders;-EASL as a problematic pattern
of alcohol use leading to clinically significant impairment or
distress ‘
• WHO still uses the terms hazardous and harmful alcohol use and
alcohol dependence
• The term ‘risky drinker’ is commonly used to define people who
drink excessively
4. Alcohol use disorders:
DSM-V criteria
*Or a closely related substance, such as benzodiazepine
EASL CPG ALD. J Hepatol 2018;69:154–81
Manifested by ≥2 of the following, occurring within a 12-month period:
1 Alcohol is often taken in larger amounts or over a longer period than was intended
2 There is a persistent desire or unsuccessful efforts to cut down or control alcohol use
3
A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from
its effects
4 Craving, or a strong desire or urge to use alcohol
5 Recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home
6
Continued alcohol use despite having persistent or recurrent social or interpersonal problems
caused or exacerbated by the effects of alcohol
7
Important social, occupational, or recreational activities are given up or reduced because of
alcohol use
8 Recurrent alcohol use in situations in which it is physically hazardous
9
Alcohol use is continued despite knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or exacerbated by alcohol
10
Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect
b. A markedly diminished effect with continued use of the same amount of alcohol
11
Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol
b. Alcohol* is taken to relieve or avoid withdrawal symptoms
5. Public health aspects:
Alcohol-related morbidity and mortality
1. WHO. Global status report on noncommunicable diseases 2014.
Available at: http://www.who.int/nmh/publications/ncd-status-report-2014/en/. Accessed August 2018;
EASL CPG ALD. J Hepatol 2018;69:154–81
• Worldwide, harmful use of alcohol is associated with:
– ~3.3 million deaths every year 1
• 5.9% of all deaths overall (7.6% in men, 4.0% in women)1
– ~139 million disability-adjusted life years
• 5.1% of the global burden of disease and injury
• Alcohol has an impact on over 200 diseases and types of injuries
• Most deaths attributable to alcohol consumption from:
– Cardiovascular diseases
– Injuries
– Gastrointestinal diseases
• Mainly cirrhosis
– Cancers
• Alcohol-attributable fraction is highest for liver diseases and foetal
alcohol syndrome
6. Public health issues:
Definitions of “drink” and “drinking”
EASL CPG ALD. J Hepatol 2018;69:154–81
• Quantification of alcohol consumption is not easy in clinical practice
• Grams of alcohol is more precise, but:
– Time consuming and frequently difficult to obtain
– Patients cannot recall the different amounts and types of drink
Term Definition
One standard drink 10 g of alcohol
Harmful drinking Where alcohol use is causing damage to either
physical or mental health
Heavy episodic drinking Consumption of more than 60 g of pure alcohol
on one occasion
Binge drinking Consumption within about 2 hours of four or
more drinks for women and five or more drinks
for men
7. Public health aspects:
Data are conflicting around a safe alcohol limit
EASL CPG ALD. J Hepatol 2018;69:154–81
• Light–moderate intake: reduced risk of coronary artery disease
• Heavy chronic alcohol intake: increased risk of cardiomyopathy,
hypertension, atrial arrhythmias and haemorrhagic stroke
• Alcohol is a recognized carcinogen
– No threshold level of consumption known for cancer risk
• Chronic use of alcohol is a risk factor for cirrhosis
• Unclear whether there is a continuous dose–response relationship
• Unclear whether there is a threshold at which the risk emerges
• Risks of binge drinking vs. daily drinking remain controversial
• Cessation of drinking at any point reduces risk of disease progression
and occurrence of complications
Recommendation
Limit daily intake to ≤2 standard drinks for women and ≤3 for men.
This amount is not associated with significant increase in cirrhosis mortality
8. Effect on motility including GERD
• In healthy volunteers, alcohol reduces the
pressure of the LES as well as the oesophageal
motility, thereby worsening the symptoms of
GERD
• However in chronic alcoholics, is said to increase
the tone of the LES but with frequent spontanous
relaxation of the LES.
• In the stomach, small quantity of alcohol is
thought to improve gastric emptying while large
percentage reduces it. Also it causes reduction in
small intestinal motility.
9. Effect on mucosa including mallory
Weiss tear
• It has direct toxic effect on the mucosa, the
injury ranges from mild erythema to
hemorrhagic gastritis.
• The mallory weiss is a linear tear in the cardia
following protracted retching after a bout of
alcohol.
10. Effect on gastric acid secretion
• In small quantity, alcohol stimulates gastric
acid secretion by action on gastrin release and
to lesser extent by direct effect on parietal
cells.
• This effect is thought to be due to presence of
maleic and succinic acid which is removed
during distillation, such that wine, champagne
has little of these property
11. Antibacterial effect
• Wine has long been known for its disinfecting and
cleansing properties, even from the biblical times.
Infact wine was used during the Prussian War to
prevent dysentery.
• It has been shown to have bactericidal effect on
salmonella, shigella and helicobacter species, action
thought to be related to the acid PH and acohol.
12. Alcohol and GI tumours
• Alcohol consumption has been linked to
increased risk of tumors in the pharynx,
esophagus, stomach and colon. Some of the
factors associated with alcohol consumption
that may favor the development of tumors
include: generation of free radicals (peroxide,
superoxide) and other oxidizing factors,
inorganic arsenic, preservatives
13. Alcohol and Pancreas
• Alcohol consumption is linked to the
development of recurrent acute pancreatitis
14. Alcoholic liver disease
• Alcohol is a major cause of chronic liver
disease in the west especially Europe and UK.
• The exact pathogenesis of alcoholic liver
injury is still not clear but immune
mediated and free radical hepatic injury
are thought to be important. Genetic
factors are thought to predispose to
hepatic injury in susceptible individuals.
15. Factors increasing susceptibility to ALD
• Lifetime intake of alcohol
• Female sex
• Genetic factors
• Drinking without food
• Binge drinking
• High concentration alcoholic drinks—for example,
spirits
• Drinking multiple different alcoholic beverages
16. Pathogenesis and spectrum of Alcohol
liver disease
• Alcohol metabolism takes place in the
mitochondria. Ethanol is oxidised to acetaldehyde
by alcohol dehydrogenase, which in turn is
oxidised to acetate by acetaldehyde
dehydrogenase.
• These oxidation reactions are associated with the
formation of NADH and NAD and alter the redox
state of the cell. This has harmful effects on lipid
and carbohydrate metabolism—for example,
steatosis.
17. Spectrum of alcohol liver disease &
pathology
• Major classification of ALD: Alcoholic fatty liver
(steatosis),
• Acute alcoholic hepatitis,
• Alcoholic cirrhosis
• Histological features of ALD: Steatosis (fatty liver)
• Mallory’s hyaline bodies
• Cholestasis
• Liver fibrosis
• Micronodular cirrhosis
•
18. Alcoholic liver disease contd.
• Diagnosis is based on accurate history, raised serum
markers such as γ-glutamyltransferase, mean
corpuscular volume, and IgA and liver histology when
obtainable.
• Abstinence is the most important aspect of treatment.
• Newer drugs such as acamprosate and naltrexone
are used to reduce alcohol craving.
• Vitamin supplements and nutrition are vital.
• corticosteroids have a role in acute alcoholic hepatitis
• Liver transplantation is beneficial in abstinent patients
with end stage liver disease
19. Public health aspects:
Screening to reduce ALD-related morbidity and mortality
EASL CPG ALD. J Hepatol 2018;69:154–81
• Early recognition and intervention are required
– Goal of abstinence or decreased alcohol consumption should be
implemented to reduce the risk of liver disease in harmful drinkers
• Screening for harmful drinking should be performed by GPs, and in
patients admitted to emergency facilities, with screening for ALD in
high-risk patients
• Suggested screening methods include:
– Blood markers
– Transient elastography
• Screening must be followed by an intervention with a multidisciplinary
team
– Specialist alcohol care teams are required to care for patients
20. Alcohol use disorders:
Screening tools: AUDIT
WHO. AUDIT. Available at: http://apps.who.int/iris/handle/10665/67205. Accessed August 2018;
EASL CPG ALD. J Hepatol 2018;69:154–81
• Developed by the WHO in 1982 and remains the gold standard
• Good sensitivity and specificity in clinical settings across countries
Question
Score
0 1 2 3 4
1. How often do you have a drink containing alcohol? Never Monthly or
less
2 to 4 times a
month
2 to 3 times
a week
4 or more
times a week
2. How many drinks containing alcohol do you have on a typical
day when you are drinking?
1 or 2 3 or 4 5 or 6 7 to 9 10 or more
3. How often do you have five or more drinks on one occasion? Never Less than
monthly
Monthly Weekly Daily or
almost daily
4. How often during the last year have you found that you were not
able to stop drinking once you had started?
Never Less than
monthly
Monthly Weekly Daily or
almost daily
5. How often during the last year have you failed to do what was
normally expected of you because of drinking?
Never Less than
monthly
Monthly Weekly Daily or
almost daily
6. How often during the last year have you needed a first drink in
the morning to get yourself going after a heavy drinking session?
Never Less than
monthly
Monthly Weekly Daily or
almost daily
7. How often during the last year have you had a feeling of guilt or
remorse after drinking?
Never Less than
monthly
Monthly Weekly Daily or
almost daily
8. How often during the last year have you been unable to
remember what happened the night before because of your
drinking?
Never Less than
monthly
Monthly Weekly Daily or
almost daily
9. Have you or someone else been injured because of your
drinking?
No – Yes, but not in
the last year
– Yes, during
the last year
10. Has a relative, friend, doctor or other healthcare worker been
concerned about your drinking or suggested you cut down?
No – Yes, but not in
the last year
– Yes, during
the last year
21. Alcohol audit-interpretation
• Question 1-3 explore consumption pattern
• Question 4-6 evaluate dependency
• Question 7-10 investigate alcohol related problems
• Total score of >8 indicate alcohol abuse disorder while
• > 20 indicate alcohol dependency
22. Alcohol use disorders:
Screening
EASL CPG ALD. J Hepatol 2018;69:154–81
• Patients with AUD have a high prevalence of psychiatric co-morbidity
– Anxiety disorders
– Affective disorders
– Schizophrenia
• At higher risk of developing other addictions
– Special attention should be paid to coordination between hepatologists
and addiction specialists (psychiatrists, psychologists, and social workers)
Recommendations
• AUDIT or AUDIT-C should be used to screen patients for
AUD and dependence
A 1
• Patients with AUD should be screened for concurrent
psychiatric disorders and other addictions
A 1
Grade of recommendation Level of evidence
23. Alcohol use disorders:
Management of alcohol withdrawal syndrome
EASL CPG ALD. J Hepatol 2018;69:154–81
• AWS is a severe medical condition affecting alcohol-dependent
patients who suddenly discontinue or decrease alcohol consumption
• Light or moderate AWS usually develops 6–24 hours after the
last drink
• Symptoms may include:
– Increased blood pressure and pulse rate
– Tremors
– Hyperreflexia
– Irritability
– Anxiety
– Headache
– Nausea and vomiting
• Symptoms may progress to more severe forms of AWS
– Characterized by delirium tremens, seizures, coma, cardiac arrest,
and death
24. Alcohol use disorders:
Management of alcohol withdrawal syndrome
EASL CPG ALD. J Hepatol 2018;69:154–81
• Pharmacological treatment is recommended for both moderate and
severe AWS
– Symptom-triggered regimen rather than fixed-dose schedule in order to
prevent accumulation
• Benzodiazepines are considered the ‘gold standard’ treatment for AWS
– Efficacy for reducing both withdrawal symptoms and the risk of seizures
and/or delirium tremens
Recommendations
• Benzodiazepines should be used to treat AWS but
should not be prescribed beyond 10–14 days because of
the potential for abuse and/or encephalopathy
A 1
Grade of recommendation Level of evidence
25. Alcohol use disorders:
Medical management of AUD in patients with ALD
1. Lackner C, et al. J Hepatol. 2017;66:6108;
EASL CPG ALD. J Hepatol 2018;69:154–81
• Alcohol abstinence is a critical goal in patients with ALD
– Abstinence improves clinical outcomes at all stages of ALD
• Naltrexone, nalmefene, disulfiram and acamprosate are approved to
treat AUD
– Disulfiram should be avoided in patients with severe ALD
• Disulfiram, naltrexone and acamprosate are approved for abstinence
Effect of abstinence during follow-up on survival probability1
0
0.0
0.2
2
0.4
0.6
0.8
1.0
4 6 8 9 10
Time (years)
Survival
probability
1 3 5 7
Abstinence
No
Yes P=0.017
0
0.0
0.2
2
0.4
0.6
0.8
1.0
4 6 8 9 10
Time (years)
Survival
probability
1 3 5 7
Abstinence
No
Yes P=0.013
Early/compensated ALD Decompensated ALD
26. Diagnostic tests in the management of ALD:
Screening and clinical diagnosis
EASL CPG ALD. J Hepatol 2018;69:154–81
• Diagnosis of ALD is usually suspected with:
– Documentation of regular alcohol consumption of >20 g/d in females
and >30 g/d in males
AND
– Presence of clinical and/or biological abnormalities suggestive of
liver injury
• A high proportion of patients with histological features of ALD do not
show any clinical symptoms or laboratory abnormalities
– Asymptomatic patients consuming a critical amount of alcohol should
undergo appropriate screening investigations
• Consider ALD in patients presenting with extrahepatic manifestations
of AUD
– E.g. symmetric peripheral neuropathy, pancreatitis, cardiomyopathy
27. Diagnostic tests in the management of ALD:
Screening investigations
*Platelets >150,000 and Fibroscan® <20
EASL CPG ALD. J Hepatol 2018;69:154–81
Rule out alternative or additional
causes of liver injury
• HBV and HCV serology
• Autoimmune markers
• Transferrin and transferrin saturation
• α1-antitrypsin
Suspected advanced fibrosis
or cirrhosis
Evaluate liver function and evidence of
portal hypertension:
• Serum albumin, prothrombin time or INR
• Serum bilirubin levels
• Platelet and WBC counts
Upper GI endoscopy for oesophageal
varices unless low risk based on Baveno
criteria*
Abnormalities on initial screening
Liver function tests (including GGT, ALT, AST)
+
Liver fibrosis (e.g. TE)
Ultrasound
28. Role of liver biopsy
• Liver biopsy generally not recommended except in the following
situations.
• Liver biopsy may be used to:
– Establish the definite diagnosis of ALD
– Assess the exact stage and prognosis of liver disease
– Exclude alternative or additional causes of liver injury
29. Diagnostic tests in the management of ALD:
Histological features and diagnosis of ALD types
Images provided courtesy of Lackner C.
EASL CPG ALD. J Hepatol 2018;69:154–81
• Lesions predominate in
centrilobular regions (in
pre-cirrhotic stages)
– Alcoholic steatosis
o Macro and eventually variable
blend of macro- and microvesicles
– Alcoholic steatohepatitis (ASH)
o Variable degree of macrovesicular
steatosis
o Hepatocellular injury with
ballooning, potentially necrosis
o Lobular inflammation
– Alcoholic fibrosis/cirhosis
o Pericellular fibrosis (PCF) and/or
septal F in precirrhotic stage
o Micronodular cirrhosis ± PCF
• A single lesion or any combination
may be found in a given individual
Main histological diagnoses:
Steatosis
Steatohepatitis
Cirrhosis
30. Diagnostic tests in the management of ALD:
Indirect markers of alcohol consumption
EASL CPG ALD. J Hepatol 2018;69:154–81
Biomarker
Biological
material
Detection
window
EtOH
amount Sens. Spec. Confounding factors
GGT Serum
Chronic
excessive
42–86% 40–84% Liver disease, BMI, sex, drugs
AST Serum
Chronic
excessive
43–68% 56–95%
Liver and muscle diseases,
BMI, drugs
ALT Serum
Chronic
excessive
30–50% 51–92% Liver disease, BMI, drugs
MCV Serum
Chronic
excessive
24–75% 56–96%
Vitamin B12,
folic acid deficiency,
haematological diseases
% CDT Serum 1–2 weeks
50–80 g/d for
>1–2 weeks
25–84% 70–98%
Liver cirrhosis/disease, nicotine,
transferrin level, weight, sex,
pregnancy, rare genetic
variations
Diagnostic performance of indirect markers is not adequate
31. Management of alcoholic hepatitis:
Evaluation of severity
*Modified version (mDF) cut-off value of 32 identifies patients with severe AH and is usually the threshold used for initiating
specific therapy
EASL CPG ALD. J Hepatol 2018;69:154–81
• Different prognostic models aim to identify patients at high risk of early death
– Often incorporate the same variables and have similar efficacy in predicting
short-term survival
• Lille model can predict pattern of response to corticosteroid treatment
– Based on pre-treatment data plus the response of serum bilirubin
Score Bilirubin PT/INR
Creatinine/
urea Leucocytes Age Albumin
Change in
bilirubin
(Day 0 to 7)
Maddrey
DF*
+ + – – – – –
MELD + + + – – – –
GAHS + + + + + – –
ABIC + + + – + + –
Lille + + + – + + +
32. Management of alcoholic hepatitis:
General measures
EASL CPG ALD. J Hepatol 2018;69:154–81
• Alcohol abstinence is the cornerstone of therapy
– Early management of AUD is recommended in all patients with AH
• Considering the potential risk of Wernicke’s encephalopathy,
supplementation with B-complex vitamins is recommended
• Other general approaches include:
– Treatment of hepatic encephalopathy (lactulose, rifaximin)
– Treatment of ascites (salt restriction)
– Prevention of renal failure in patients with severe AH
• Avoidance of diuretics and nephrotoxic drugs
• Volume expansion if needed
• Use of beta-blockers may increase the risk of AKI
33. Management of alcoholic hepatitis:
Nutrition
EASL CPG ALD. J Hepatol 2018;69:154–81
• Protein energy malnutrition is present in almost every patient with
severe AH, and is associated with poor prognosis
• Use of tube feeding is strongly recommended if patients are not able to
maintain adequate oral intake
• Insufficient evidence to support a recommendation for parenteral
nutrition, particularly given the high risk of line sepsis
Recommendations
A careful evaluation of nutritional status should be performed; patients
should aim to achieve a daily energy intake ≥35–40 kcal/kg BW and
1.2–1.5 g/kg protein, and to adopt oral route as first-line
intervention
A 2
Grade of recommendation Level of evidence
34. Management of alcoholic hepatitis:
Corticosteroids
*Prednisolone 40 mg/day or methylprednisolone 32 mg/day
EASL CPG ALD. J Hepatol 2018;69:154–81
• Use of corticosteroids is limited by concerns about heightened risks of sepsis and
gastrointestinal bleeding
• Early identification of non-responders to corticosteroids is important to define stopping
rules and limit unnecessary exposure
• At the end of the course of treatment corticosteroids can be stopped immediately or
the dose tapered over a period of 3 weeks
Recommendations
In the absence of active infection, corticosteroids* should be
considered in patients with severe AH to reduce short-term mortality
A 1
N-acetylcysteine (for 5 days, intravenously) may be combined with
corticosteroids in patients with severe AH
B 2
Early non-response (at Day 7) to corticosteroids should be identified
and strict rules for the cessation of therapy should be applied
A 1
In case of non-response to corticosteroids, highly selected patients
should be considered for early liver transplantation
A 1
Grade of recommendation Level of evidence
35. Management of alcoholic hepatitis:
Infection
EASL CPG ALD. J Hepatol 2018;69:154–81
• Infection is a frequent and severe complication in patients with severe AH, and
is one of the major causes of death
– Bacterial infections are responsible for 90% of infectious episodes
– Invasive aspergillosis has been reported as a complication associated with
poor outcome
– Sporadic cases of pneumocystis pneumonia have been described in patients with
severe AH and concomitant corticosteroid treatment, with a very high mortality rate
• Corticosteroids do not appear to increase the risk of infection or mortality from
infection, but may exacerbate infection
Recommendations
Systematic screening for infection should be performed before
initiating therapy, during corticosteroid treatment, and during
follow-up period
A 1
Grade of recommendation Level of evidence
36. Alcohol-related fibrosis and cirrhosis
*Ascites, jaundice, variceal bleeding, infections, hepatorenal syndrome, hepatic encephalopathy, cachexia
EASL CPG ALD. J Hepatol 2018;69:154–81
• A range of environmental and host factors have been linked with risk of
progression to advanced ALD (extensive liver fibrosis and cirrhosis)
– Cigarette smoking, gender, ethnicity, comorbid conditions (e.g. diabetes
and obesity), microbial dysbiosis, chronic infection with HBV and HCV
and/or HIV, α-antitrypsin deficiency, iron overload
– Genetic risk factors
• Polymorphisms in the PNPLA3 gene
• Genetic variants on TM6SF2 and MBOAT7
– Type and pattern of alcohol use
• ALD cirrhosis may present as compensated or decompensated*
– May also be associated with extrahepatic alcohol-related organ damage
• Alcohol-related cardiomyopathy, acute and chronic pancreatitis, central and
peripheral nerve involvement, hepatic encephalopathy
37. Management of suspected alcoholic hepatitis:
Treatment algorithm
*Particularly in null responders (Lille score ≥0.56).
EASL CPG ALD. J Hepatol 2018;69:154–81
Stop treatment* and assessment
for early liver transplantation in
highly selected patients
Continue treatment for 28 days
Lille score ≥0.45
Lille score <0.45
mDF <32 and GAHS <9
Assess treatment response at
Day 7 (Lille score)
Prednisolone 40 mg/day ± NAC No specific therapy
mDF ≥32 or GAHS ≥9
Assessment of disease severity
(prognostic scores)
• Systematic evaluation of nutritional
status and energy intake
• Daily target 35–40 kcal/kg BW
• Prefer oral route as first-line intervention
• Supplementation with B-complex
vitamins
Consider liver biopsy if
diagnosis is uncertain
Perform systematic extensive
screening for infection
Treatment of alcohol
dependence
Clinical diagnosis of AH
38. Liver transplantation:
Trends in liver transplantation of ALD
1. Data from European Liver Transplant Registry; EASL CPG ALD. J Hepatol 2018;69:154–81
• LT is the most effective therapeutic option for patients with ESLD
– 1-year post-transplant patient and graft survival is ~80–85%
• Liver outcomes after LT in patients with AUD have improved
– Graft and patient survival now similar to after LT for other aetiologies
• Alcohol-related cirrhosis represents an increasing proportion of LTs in Europe1
ALD cirrhosis (24,452)
Autoimmune cirrhosis (2,992)
Cryptogenic (unknown) cirrhosis (5,750)
Other cirrhosis (2,880)
Primary biliary cirrhosis (8,130)
Secondary biliary cirrhosis (998)
Viral + cirrhosis due to alcohol (2,792)
Virus-related cirrhosis (28,043)
0
20
40
60
80
100
Percentage
Aetiology of cirrhosis leading to LT in Europe
39. Public health aspects:
Policies to reduce population risk for ALD
EASL CPG ALD. J Hepatol 2018;69:154–81
• Effective interventions include:
– Price based policies
• Taxation
• Minimum unit pricing
– Limitation of alcohol availability
– Restriction of marketing and advertising
• Policies based on age-related vulnerability
– Partial or total advertising bans
– Restrictions on access to alcohol through minimum ages at which it is legal
to purchase alcohol
– Laws to prevent any alcohol consumption by young people when
driving vehicles