Systemic effects of alcohol

Alcohol comes under a category of drugsUsed in therapeutics 1.Ablation therapy 2.Trigeminal neuralgia 3.Methanol poisoning

Its potential to be the most abused drug has made it a topic for discussion

Effects 1.Physical 2.Emotional 3.Social

The physical effects of alcohol will be dealt with

Effect on nervous system

1.Black outs an episode of temporary anterograde amnesia, in which the

person forgets all or part of what occurred during a drinking eveningalmost every person branded as an alcoholic has experienced atleast

one such event……….

2.Altered sleep pattern amount spent in REM sleep is reduced

3. Sleep apnea alcohol acts as a pharyngeal muscle relaxant common in elderly alcoholics

4.Hangover fatigue, headache, thirst and nausea

5.Peripheral neuropathy 5- 15 % of chronic alcoholics develop peripheral neuropathy predominantly small fibre neuropathy painful peripheral neuropathy distal and bilateral6.Cerebellar degeneration Bilateral affects vermis gait disturbance and nystagmus7.Cognitive impairement impaired judgement

8.Wernickes syndrome predominant thiamine deficiency ophthalmoparesis, ataxia, and encephalopathy individuals with transketolase deficiency are predisposed

9.Korsakoffs psychosis retrograde amnesia confabulation10. Marchiafava-Bignami Disease corpus callosal degeneration progressive pyramidal tract signs, stupor and coma progressive dementia11.Muscle atrophy proximal muscle involvement

12. Alcohol binge - rhabdomyolysis acute proximal muscle weakness CPK increased 50 fold myoglobinuria and renal failure

13.Subdural hematoma increased frequency of trivial fall can present with cognition abnormality, hemiparesis,gait

disturbances

Effects on GIT and hepatobiliary system

Esophagus and stomach GERD, Mallory Weiss tear, hemorrhaghic gastritis

Oral and esophageal cancer 2 times more common than in non alcoholics

Pancreatitis Acute and chronic pancretitis usually acalculous hemorrhaghic pancreatitis common duration of alcohol does not matter much common during acute binge drinking

Liver – alcoholic liver disease 1.Fatty liver 2.Alcoholic hepatitis 3.CirrhosisFatty liver – stage of reversibility

Alcoholic hepatitis Inflammation of liver cells Mallory bodies Balloning degenaration of cells

Patient presents with jaundice, fatiguability,bleeding tendency, tender hepatomegalyReversibleAbstinence is the best treatmentOther supportive management

Cirrhosis 15% of chronic alcoholics micronodular and macronodular cirrhosis all features of decompensated liver disease Asscoiation with Hepatitis C virus common This dreaded association has increased tendency to develop Hepatocellular carcinoma(HCC)

Rectal carcinoma Incidence is increased two fold

Effects on cardiovascular system

1.Cardiomyopathy a form of dilated cardiomyopathy systolic dysfunction

2.Holiday heart syndrome sudden cardiac death due to arrythmia due to alcohol binge

3.Coronary heart disease six fold increase in chronic heavy drinkers

30 – 40 % increase in cardiovascular mortality

Effects on genitourinary system

MENModest ethanol doses increase sexual drive Decrease erectile capacity Irreversible testicular atrophy shrinkage of the seminiferous tubules, decreases in ejaculate volume lower sperm count

WOMENamenorrhea decrease in ovarian size absence of corpora lutea with associated infertility increased risk of spontaneous abortion.

Effects on Hematopoietic systemIncrease in red blood cell size MCV folic acid deficiency hypersegmented neutrophils, reticulocytopenia, hyperplastic bone marrow

Decrease production of white blood cells, decrease granulocyte mobility and adherence, impair delayed-hypersensitivity

Mild thrombocytopenia

Effects on hormones

increase in cortisol levels, inhibition of vasopressin secretion reversible decrease in serum thyroxine (T4)

decrease in serum triiodothyronine (T3).

Most hormone abnormalities are corrected with abstinence

Reduces bone density

Fetal Alcohol Syndrome

Heavy drinking during pregnancy results in rapid placental transfer of both ethanol and acetaldehyde serious consequences for fetal development. Any amount of alcohol can be hazardous No trimester relation observed Best way to prevent is ABSTINENCE

Fetal alcohol syndrome include :

1.A smooth philtrum — The divot or groove between the nose and upper lip flattens with increased prenatal alcohol exposure.

2.Thin vermilion — The upper lip thins with increased prenatal alcohol exposure.

3.Small palpebral fissures — Eye width decreases with increased prenatal alcohol exposure

Fetal alcohol syndrome include : facial changes with epicanthal eye foldspoorly formed ear conchasmall teeth with faulty enamelcardiac atrial or ventricular septal defectsan aberrant palmar crease limitation in joint movementmicrocephaly with mental retardation

The main effect of FAS is permanent central nervous system damage, especially to the brain.