Medical aspects of alcoholism

Alcohol misuse

Understanding Alcoholism

Everyone in the healthcare field should understand the medical aspects of alcoholism. There are medications that can help with the treatment of alcoholism or the consequences of alcohol misuse. Not all misuse of alcohol is alcoholism, but any drinking that’s over a moderate amount can create medical issues.

There are drugs for detox from alcoholism, drugs that make a person sick when they drink alcohol, drugs that counter the pleasurable feeling received from alcohol, drugs that help with anxiety during withdrawal from alcohol, drugs that prevent seizures when a person is withdrawing from alcohol and drugs that repair the physical damage caused by heavy drinking.

But before the treatment of alcoholism or alcohol misuse can begin, there must first be a recognition of medical signs and symptoms:

I. GENERAL APPEARANCE

A. Hand Tremor

Part of alcohol withdrawal. Can begin within hours after cessation of alcohol

intake. Mild expression of withdrawal.

B. Excitability, Irritability, Nervousness

This stems from the sedative effect of alcohol being removed – the body

rebounds from depression of the central nervous system to stimulation. This

may also be part of first stage alcohol withdrawal, resulting from the decrease of

alcohol in the blood stream. Also caused by lack of sleep; alcohol can cause a

disturbance in REM sleep. REM sleep is necessary for the body to physically

and psychologically recover each and every day.

C. Jaundice

The result of liver damage. The yellow color comes from the pigment found in

bile, a digestive juice made by the liver (the liver secretes 500 ml of bile/day).

Bile is handled improperly and thus begins to circulate in the bloodstream,

causing the skin color to change to yellow

D. Rosacea, Seborrheic Dermatitis (dry, red, itchy skin)

Caused by a nutritional deficiency, especially B vitamin, as well as poor personal

hygiene

E. Parotid Swelling

Alcohol affects salivary glands which leads to an increased stickiness of saliva,

causing blockage of salivary ducts and a mumps-like appearance due to swelling

of parotid gland.

F. Finger Clubbing

Referred to as “Drumstick” disease. Tips of fingers swell, causing a puffiness

that covers the fingernails. The cause is alcohol cardiomyopathy, resulting in

poor circulation to extremities.

G. Rhinophyma (“Drinker’s Nose”)

A painless increase in nasal sweat glands which causes an increase in the size

of the lower part of the nose.

II. GASTROINTESTINAL TRACT

A. Dyspepsia

A general feeling of discomfort after eating. Due to imperfect digestion (not an

illness itself, but a symptom of one). A sign of gastritis, which is inflammation of

the stomach and is the most common GI ailment stemming from alcoholism.

B.Nausea & Vomiting

Vomiting has been referred to as the body’s “housecleaning” – when the body is

unable to process food in the stomach, the system tends to force its removal.

Also a sign of gastritis.

C. Recurrent Diarrhea

Alcohol changes the motility of the intestinal tract. The first 16 to 20 inches of the

small intestine are impacted. Once the stomach deposits chyme (gruel-like

material produced by gastric digestion of food) in the small intestine, the body

should begin to absorb the necessary food stuff for use and storage. Alcohol in

the blood stream inhibits the small intestine from absorbing certain minerals and

nutrients from the chyme, causing it to function improperly. Beyond that point,

alcohol causes an increase in the rate of propulsion of food through the small

intestine. This results in malabsorption of food in the remainder of the small

intestine.

D. Recurrent Abdominal Pain

Alcohol causes inflammation of stomach and colon.

E. Acute & Chronic Pancreatitis

About 50% of all cases of pancreatitis are alcohol related. Alcohol has a direct

toxic effect on the pancreas, causing changes in the secretions of the pancreas.

Increased secretion of digestive juices can produce pancreatic irritation and

damage. Most researchers believe that the disease-causing mechanism is the

alcohol-induced increase in protein concentration in pancreatic juice –

precipitates and clogs the ducts of the organ.

1. Acute pancreatitis

Most often seen in men, 26-65 years of age, with a minimum of 5-10 years of

active drinking.

Symptoms: Constant, severe epigastric pain which may radiate to the back;

nausea and vomiting. Usually begins one or two days after heavy use.

2. Chronic pancreatitis

Gradual, subtle onset with severe pain

F. Hypoglycemia & Hyperglycemia

Alcohol causes rapid change in blood sugar – with the increase of alcohol in the

blood stream, the pancreas responds with an increased output of insulin that

leads to a decrease of blood sugar. This decrease causes the liver to produce

glycogen to replace the lost blood sugar, generally resulting in an increase in

blood sugar.

G. Gastrointestinal Bleeding

Prime cause is the destruction of the stomach lining due to an increase in

stomach acids. This may also result in ulcers, causing additional bleeding.

H. Liver

Metabolizing alcohol is always a priority for the liver (approximately 1/2 ounce of

ETOH per hour). The toxic effects of alcohol can cause several problems, even

with proper nutrition:

1. Alcohol fatty liver – Liver overproduces glycogen to compensate for lost sugar

in bloodstream; Metabolism of alcohol leads to accumulation of free fatty acids

which leads to an increased concentration of fat in the liver.

Signs and Symptoms: liver enlargement; changes in liver enzymes (detectable

on a routine lab examination).

2. Alcoholic hepatitis – Syndrome of necrosis (cell death) and inflammation may

occur rapid or over a long period of time.

Signs and Symptoms: Hepatomegaly (enlarged liver), jaundice, liver pain, fever,

leukocytosis (increased WBC’s), ascities – cirrhosis may result from this

condition.

3. Cirrhosis – Advanced necrosis with resultant scarring associated with formation

of nodules – generally irreversible to 100%, though liver can reproduce tissues to

restore a greater level of health with abstinence.

4. Ascites – the accumulation of fluid in the abdominal cavity. Due to an increase

in the size of the liver and compression of the liver on blood vessels, resulting in

the leakage of fluid from the liver into the abdominal cavity. A tell-tale sign of this

condition is the wave-like action of the abdominal cavity when tapped, as well as

the skin tone appearing paper thin and glistening.

III. CARDIOVASCULAR

A. Palpitations

Irregularity in heartbeat occurs both in patients with alcohol related diseases and

in other individuals during alcohol intoxication.

B. Cardiomyopathy

Otherwise known as heart disease – one out of thirty-six alcoholics develop this

condition

Signs and symptoms: Chronic shortness of breath and signs of congestive heart

failure.

C. Anemia

Alcohol inhibits the bone marrow’s ability to use iron in making hemoglobin, the

oxygen-carrying part of blood. B12 not taken in or poorly stored which leads to

immature RBC’s or WBC’s. Incomplete production of red blood cells; defect in

RBC maturation leads to macrocytosis (enlargement) and increased Mean

Corpuscular Volume (MCV). Bone marrow is sedated by alcohol – unable to

produce as many RBC’s or WBC’s. Three drinks destroy as many platelets as

you can make in one day. This leads to bruising and high clotting times.

D. Dilation of Blood Vessels

Alcohol causes peripheral blood vessels to dilate and leads to a loss of body

heat. Many people drink straight spirits in cold weather to increase warmth when

in reality alcohol causes the body to lose its internal heat. Such an effect can

lead to frostbite. Body temperature regulate is also impaired.

IV. RESPIRATORY SYSTEMS

A. Chronic Obstructive Airways Disease (COAD)

Related to loss of air capacity of lungs and loss of elasticity – alcohol contributes

to this. Alcohol has a direct toxic effect on lung tissue and kills the alveoli (air

sacs) in the lungs.

B. Recurrent Chest Infection and Pneumonia

Alcohol dries lung tissue and bronchi and causes them to become irritated and

inflamed and susceptible to infection. Alcoholics have decreased ability to fight

infections due to suppression of the immune system (decreased WBC’s and

machrophage). Alcohol has a numbing effect and makes it hard to get secretions

out of the lung.

V. CENTRAL NERVOUS SYSTEM

A. Impact on Neurons (Brain Cells)

It has long been estimated that each drink of alcohol kills approximately 10,000

neurons. Recent scientific findings now suggest that the cells may not actually

die, but be “disconnected” as a result of drinking and not be able to perform their

tasks. Either way, neurons are specialized cells that do not reproduce. Alcohol

thickens the conductive material between brain cells, slowing down electrical

impulses – cell has trouble referring impulses from one cell to the next. Damage

to the brain caused by alcohol particularly affects the frontal lobes, making a

person unable to give up behavior patterns which are harmful. He is unable to

make long-range plans and use intellect for decision making. May take up to two

years for all functions to return, if they do at all.

B. Short-Term Memory Impairment

Alcohol interferes with brain functioning and can cause loss of memory,

particularly for recent events. Chronic drinking for ten days or more leads to

impaired protein synthesis which leads to brain cell damage. Memory tends to

return to normal after a period of abstinence from alcohol.

C. Blackouts

Short-term memory loss is like a period of amnesia. Quantity of alcohol

consumed seems to have no direct relationship to frequency of blackouts.

D. Seizures

Tend to occur from 7-48 hours after cessation of drinking. Commonly of the

grand mal type, but can also be petit mal seizures: 1-3% of all chronic abusers

will have seizures. Chronic alcoholism results in an abnormally elevated seizure

threshold followed by a period of lowered seizure threshold; this, plus decreased

blood alcohol level, altered electrolytes, and decreased blood glucose, can lead

to seizures.

E. Peripheral Neuropathy (nerve disease)

Vitamin B deficiency, especially thiamine, leads to peripheral neuropathy (tingling

and numbness in hands and feet). Vitamin B deficiency leads to impaired

production of the enzymes needed for maintaining the covering of the nerve

cells. This loss causes destruction of nerve cells which results in tingling and

numbness, as well as muscle weakness.

F. Ataxia (Loss of Balance)

Results of peripheral neuropathy (nerve damage)- loss of balance and

coordination occurs which results in the characteristic of the “wide based gait” in

order to keep balance. Late onset, generally develops over months of use, a

result of vitamin B deficiency

G. Insomnia, Nightmares

Large amount of alcohol disturbs REM sleep. Brain forces REM sleep, resulting

in dreams that are intense, nightmare in quality.

H. Hallucinations

Basically means that the brain is so sick and irritable that it sees, hears and feels

things that aren’t there. Agitated condition breaks through because alcohol has

raised agitation so high that no amount of current sedation can reduce it

I. Delirium Tremens

Late stage withdrawal phenomenon. Sensory input plus motor output has

become tremendous, and alcoholic is unable to stop moving.

All four stages of withdrawal present:

1. Hyperarousal,

2. Hallucinations,

3. Convulsive seizures,

4. Delirium Tremens.

Observable features include restlessness, increased blood pressure (especially

diastolic reading), increased pulse and low-grade temperature.

J. Wernicke Syndrome, Korsakoff Psychosis

Both caused by nutritional deficiencies, especially the loss of thiamine, plus toxic

effects of alcohol on nerve tissue

1. Wernicke Syndrome – Injury to the brainstem and areas near the third and

fourth ventricle of the brain – results in:

Diplopia (double-vision),

Hyperactivity and delirium. Responds rapidly to vitamins – this condition is

reversible with vitamin replacement.

Signs and symptoms: Confused, delirious and apprehensive. Characteristic

dysfunction: Nystagmus (eyes do not track together), ataxia.

2. Korsakoff Psychosis – Chronic brain damage caused by thiamine deficiency.

Sludging of dead red blood cell components in small capillaries results in cell and

tissue destruction due to hyposia (lack of oxygen); Damage occurs to the

cerebral cortex and peripheral nerve tissue.

Signs and symptoms: Severe disorientation, delirium, memory loss and

confabulation (hallmark sign – due to memory loss, the individual generally

makes up elaborate stories to cover the loss or to fill in holes in the memory).

VII. MUSKULOSKELETAL

A. Muscle Atrophy

Wasting of muscles due to improper nourishment to muscle tissue – can result in

acute pain in upper arms, shoulders and pelvic area.

B. Alcoholic Myopathy

Long-term alcohol use produces increased levels of enzyme serum creatine and

phosphokinase, resulting in muscle cramps, weakness.

Acute symptoms:

Sudden onset of weakness – may be acute pain in skeletal muscles;

Follows drinking bout;

Involves proximal muscles, extremities, pelvic and shoulder girdle, muscles of

the thoracic cage.

Chronic symptoms:

Muscle weakness involving muscle groups as listed above, but without pain

or tenderness;

Enzymes on blood test are not elevated, making it difficult to diagnose the

problem, especially if the person denies drinking.

C. Nephritis (Inflammation of the Kidneys)

Kidneys fail to operate efficiently, leaking out blood cells, albumin, etc. May

result in a red color to the urine.

D. Amenorrhea (Loss of Menstruation)

Alcohol interferes with the absorption of calcium which is needed for the ovaries

to work efficiently. Use of alcohol may cause women to skip menstrual periods.

Alcohol interferes with the absorption of calcium which is needed for the ovaries

to work efficiently. Not as much known about women’s disorders in general since

the increase of women in treatment is relatively new, and research is lacking.

E. Impotence

Use of alcohol decreases testosterone, increases estrogen in the male (liver fails

to work properly to assist in sex hormone levels). Results in feminization

features (loss of facial hair, possible breast enlargement). Alcohol also has a

direct toxic effect on testes and leads to a decreased plasma testosterone,

decreased fertility and atrophic (shrunken) testes.

VIII. GENITOURINARY

A. Polyuria (increased urine flow)

Alcohol has a diuretic effect while blood alcohol increases. Diuresis caused by

supression of the release of anti-diuretic hormones from the pituitary gland. ADH

allows kidneys to filter water from urine, reabsorbing water and moving urine to

bladder for disposal. With loss of filtering ability, the kidneys pass the water with

the urine, generally causing an increase urge to void. Extent of diuresis is

dependent on a rising blood alcohol condition and the rate of rise. As BAC

becomes steady or falls, effect is reversed and the body actually can cause the

retention of urine and exacerbation of urinary tract infections and/or prostatitis.

B. Electrolyte Imbalance

Excretion of sodium and chloride is decreased due to drinking. Alcohol causes

the loss of magnesium which leads to restlessness, mental slowing.

IX. LAB VALUES TO OBSERVE

Many of the problems and conditions discussed above may not materialize until many

years of problem drinking has existed. Waiting for physical conditions to occur before

diagnosing the problem of alcoholism has lead to the extraordinarily high death rate.

Yet current research suggests that various indicators do exist that signal the likelihood

of alcoholism. A standard blood test can give an indication of the internal workings of

the human body, as well as a look at how alcohol might be causing disruption to the

normally healthy systems.

Research suggests that by looking for the following values on a blood test, an effective

diagnosis might be reached well in advance of physical tissue destruction:

1. Increased Uric Acid

2. Increased Triglycerides

3. Increased GGT

4. Increased MCV (mean corpuscular volume)(due to cell being deficient in B12

and folic acid – cell has to work harder and grows larger)

5. Increased Alkaline Phosphatose (true in cases of chronic alcoholism

Studies

I could have linked to this long list, but I wanted to have a post that truly reflects the damage caused by alcoholism or alcohol misuse.