At the end of this session you will be able to download from Nathan Bodington some short answer questions to complete. Answer these questions on the sheet provided and hand in to your demonstrator at Work Session 7.You should also upload a copy of your answers to the pigeonhole on Nathan Bodington. This assessment contributes 30% of your final in-course mark
Table 1: metabolic processes carried out by the liver and their functional significance in the body
Mortality and morbidity in UK far outstrips other drugs in its effects on individuals and society. It is hard to accurately assess the social effects of alcohol misuse, but it is generally accepted that it is a factor in family disputes, marital breakdown, child neglect and abuse, absenteeism from work, vandalism, physical assault and petty crime. There is a direct relationship between the overall level of alcohol consumption within a population and the number of alcohol-dependent people. Nations with widespread use and high consumption per head, have a proportionately higher rate of alcohol-related diseases than those with a lower consumption per head.
Unlike most drugs, there are no specific receptors in the body for alcohol, and it affects all organs. The effect of alcohol falls into two categories:
Alcohol depresses the brain functions initially by inhibiting the reticular activating system (RAS), which regulates the front part of the brain, the cerebral cortex. The effect of this is to diminish intellectual faculties and also to reduce the inhibitory effect of the cerebral cortex on other areas, resulting in a lack of integration between sensory and motor control. The outcome is loss of coordination, judgement and control over movement.
People who misuse alcohol become physically dependent, and require alcohol to prevent unpleasant consequences of abstinence, called rebound hyperactivity. This occurs because the inhibitory effect of alcohol on the RAS is removed, and results in persistent tremor, extreme agitation and restlessness, sleeplessness, sweating, sometimes accompanied by frightening visual hallucinations.
Alcohol damages many tissues with which it has contact. Liver damage may occur in people who regularly consume even just slightly more than the recommended limit, and this often has knock-on effects on other organs, resulting in a variety of potentially serious conditions.
The table below summarises the effects of different concentrations of alcohol in the blood. (One unit represents approximately 200mmol or 8g alcohol).
Units of alcohol
Effects of alcohol on behaviour
Reduced tension, relaxed feeling, increased confidence.
Euphoria, loss of fine motor control, impaired judgement, loss of inhibitions, flushed skin.
Slowing of reflexes, slurred speech, impaired coordination judgement, attention and control.
Erratic behaviour, little control of voluntary activity, loss of balance and staggering gait, signs of aggression and emotion, double vision, loss of memory and comprehension.
Extreme confusion, poor coordination, inability to stand, vomiting, incontinence, lowering of blood pressure and body temperature, poor respiration, clammy skin.
Coma, depression of respiratory centres, death likely above 500 mg/dl.
THE CASE STUDIES
Bill C., an unemployed labourer, aged 55, had been a heavy beer drinker for years and was admitted to hospital after collapsing in the street. He was clearly unsteady on his feet, confused and with a strong smell of alcohol on his breath. His blood alcohol concentration was 78 mM. Physical examination revealed tender enlargement of the liver. He complained of general loss of appetite, fatigue, early morning nausea and frequent gastro-intestinal problems. Occasional vomiting of blood had been reported. Mary P., aged 42, also presented with gastro-intestinal problems and frequent diarrhoea. She had been under considerable stress at work and admitted to concerns about her alcohol consumption.
It was felt advisable to perform a set of liver function tests on both patients and the results are shown below:
Total protein (g/l)
Total bilirubin (mM)
Alkaline phosphatase (U/l)
Alanine transaminase (U/l)
Aspartate transaminase (U/l)
g-glutamyl transferase (U/l)
Heavy drinkers are regularly admitted to Accident and Emergency departments, in a comatose state due to hypoglycaemia.
Why is hypoglycaemia more likely to occur amongst alcohol addicts?
Why arethese patients always given an i.v. injection of thiamine (vitamin B1) before administration of glucose?
MANAGEMENT OF THE CONDITION
You may be interested in the following paper, written by Leeds medical students, about alcohol intake in second year medical students.
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