Medical English

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PEDRO RUIZ GALLO NATIONAL UNIVERSITYHuman

Medicine School

MEMBERS:

BONILLA MAYTA YEIMI DIAZ CARRION EDDIE GUEVARA COTRINA CRISTHIAN PORTILLA SUAREZ JONATHAN VIDAURREE CARLOS CARLOS

TEAM 9

Dr. Rosa Gonzales Llontop

Introduction

Alcoholism is the addiction to or dependency upon drinking excessive amounts of alcoholic beverages.[1] Since the late 20th century, it has been considered an addictive

disorder. It is characterized by compulsive and uncontrolled consumption of alcohol, usually to the detriment of the drinker's health, personal relationships, and social

standing. Like other drug addictions, alcoholism is medically defined as a treatable disease.

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Set of symptoms that can occur when a person suddenly stops drinking after been drinking too much alcohol every day.

Causes

Alcohol withdrawal occurs more frequently in adults but can occur in teenagers or children.The more you drink each day is more likely to exhibit the symptoms of alcohol withdrawal when stopping.

Symptoms

The alcohol withdrawal symptoms usually occur within 5 to 10 hours after the last drink, but can occur days later. Symptoms worsen in 48 to 72 hours and may continue for weeks.

Common symptoms include:• Anxiety or nervousness• Depression• Trouble thinking clearly• Fatigue • Irritability • shocks or tremors• Ups and downs in mood• Nightmares

Other symptoms may include:• Clammy skin• Pupils dilated• Headache• Insomnia • Loss of appetite• Nausea and vomiting• Pale• Rapid heart rate• Trembling hands and other body parts

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ALCOHOL-RELATED DISEASES

Alcohol withdrawal

Exams and Tests

The doctor will perform a physical exam. This may reveal:

• Abnormal eye movements• Abnormal heart rhythms• Insufficiency of body fluids (dehydration) • Fever• Rapid breathing• Rapid heart rate• Hands trembling

You can perform blood and urine tests as a drug test.

Treatment

Treatment goals include: • To reduce withdrawal symptoms or withdrawal.• Prevent complications.• Therapy to get you to stop drinking (abstinence).

HOSPITAL DETOXIFICATION

People with alcohol withdrawal symptoms from mild to severe may need hospital treatment in a hospital or other facility that treats this type of withdrawal.

Treatment may include:

• Monitor blood pressure, body temperature, heart rate and blood levels of different chemicals in the body.• Liquids or medications through a vein (IV).• Sedation using drugs called benzodiazepines until withdrawal is complete.

OUTPATIENT TREATMENT

If you have symptoms of alcohol withdrawal may need mild to moderate outpatient treatment in a hospital or other facility that treats this type of withdrawal. You will need someone to commit to stay with you during this process and you can watch. They need daily visits to a doctor until you stabilize.

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Alcoholic liver disease is damage to the liver and its function due to alcohol abuse.

Causes

Alcoholic liver disease usually occurs after years of drinking too much. The longer the alcohol use has occurred, and the more alcohol that was consumed, the greater the likelihood of developing liver disease.

Alcohol may cause swelling and inflammation (hepatitis) in the liver. Over time, this can lead to scarring and then cirrhosis of the liver. Cirrhosis is the final phase of alcoholic liver disease.

Other important factors include:

Alcoholic liver disease may be more common in some families This disease does not occur in all heavy drinkers You do not have to get drunk for the disease to develop Women may be more susceptible than men People who drink too much, too often do not get enough healthy foods and

nutrients. Poor nutrition may make liver disease worse.

Acute alcoholic hepatitis may be caused by binge drinking (five drinks for men, four drinks for women). It may be life-threatening.

Symptoms

Symptoms vary based on the severity of the disease. They are usually worse after a recent period of heavy drinking.

Symptoms may not be present until the disease is advanced.

General symptoms include:

Abdominal pain and tenderness Dry mouth and increased thirst Fatigue Jaundice Loss of appetite Nausea

Swelling or fluid buildup in the legs (edema) and in the abdomen (ascites) when cirrhosis is present

Weight loss

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Alcoholic liver disease

Skin changes include:

Abnormally dark or light skin Redness on feet or hands Small, red spider-like blood vessels on the skin Yellow color in the skin, mucus membranes, or eyes

(jaundice)

Abnormal bleeding:

Bloody, dark black, or tarry bowel movements (melena)

Nosebleeds or bleeding gums Vomiting blood or material that looks like coffee

grounds

Brain and nervous system symptoms:

Agitation (being stirred up, excited, or irritable) Changing mood Confusion (encephalopathy) Periods of decreased alertness or awareness Hallucinations Impaired short- or long-term memory Pain, numbness, or tingling in the arms or legs Problems paying attention or concentrating Poor judgment Slow, sluggish movements

Other symptoms that can occur with this disease:

Breast development in males Light-headedness or fainting, especially when rising to standing position Paleness Exams and Tests Complete blood count (CBC) Liver biopsy Liver function tests such as ALP

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Tests to rule out other diseases include:

Abdominal CT scan Blood tests for other causes of liver disease Ultrasound of the abdomen

Treatment

The most important part of treatment is to stop using alcohol completely. If liver cirrhosis has not yet occurred, the liver can heal if you stop drinking alcohol.

An alcohol rehabilitation program or counseling may be necessary to break the alcohol addiction. Vitamins, especially B-complex and folic acid, can help reverse malnutrition.

If cirrhosis develops, you will need to manage the complications of cirrhosis. You may need a liver transplant.

Cirrhosis is the result of damage accumulated in the liver, characterized by the accumulation of fibrosis ("scars") in liver tissue and decreased functioning liver tissue. These changes in liver structure and interfere with normal functioning of the liver, causing serious complications in the circulation of blood through the liver.

CAUSES

There are many causes that can lead to liver cirrhosis, the main are:

• Hepatitis B virus, hepatitis C and hepatitis D.• Excessive consumption of alcohol. • Nonalcoholic fatty liver: A condition common in the general population, associated with diabetes and obesity.• Autoimmune Diseases: Autoimmune hepatitis and primary biliary cirrhosis.• Prolonged bile duct obstruction, such as sclerosing cholangitis.• Lack of specific proteins or enzymes to metabolize different substances in the liver, as the deficiency of alpha 1-antitrypsin.• Certain diseases of the heart (heart failure).• Severe reaction to drugs or medications.• Prolonged exposure to toxic agents in the environment.

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CIRRHOSIS

SIGNS AND SYMPTOMS

The principle of cirrhosis is usually silent still very few specific symptoms. As damage accumulates in the liver, may receive the following symptoms:

• Loss of appetite.• Malaise.• Nausea and vomiting. • Weight loss.• Enlargement of the liver.• Jaundice or yellowing of the skin and whites of the eyes, due to the accumulation of blood when the liver is not able to remove either the bile.• Itching.• Ascites or fluid buildup in the abdomen.• Vomiting blood, broken veins (varices) in the lower esophagus.• Encephalopathy, or changes of consciousness, which can be subtle (confusion) or deep (coma).

The diagnosis of cirrhosis can be unexpected. A person may present to the doctor with symptoms of liver disease do not appear and after a physical examination and blood tests to discover that tempt cirrhosis.

TREATMENT

The treatment for cirrhosis depends on the person suffering from cirrhosis, the time has gone on the disease and has suffered permanent damage to the liver. Sometimes the damage to the liver can be corrected by locating the specific cause of cirrhosis and is given appropriate treatment.

• In the case of alcoholic cirrhosis, total abstinence and a balanced diet are important parts of treatment.

• In the case of cirrhosis secondary to viral hepatitis, drugs are used to enhance immune system response against the virus, such as interferon.

• In cases of cirrhosis caused by autoimmune hepatitis, corticosteroids alone or in combination with azathioprine may be an effective treatment.

• In cirrhotic patients with jaundice, treatment with supplemental fat soluble vitamins can help.

• In the case of Wilson's disease, it removes excessive amounts of copper in the body through medication.

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• In hemochromatosis, removing excess iron by phlebotomy (blood removal).

• Many types of cirrhosis requiring liver transplantation when advanced liver failure.

WHAT ARE THE COMPLICATIONS OF CIRRHOSIS?

Complications of cirrhosis include ascites, hepatic encephalopathy and bleeding from ruptured esophageal varices.

• Ascites is treated by reducing salt intake plus administration of diuretics. In some cases it is necessary to direct disposal of large amounts of fluid in the abdomen through a catheter through the abdominal wall, also called paracentesis.

• Treatment of hepatic coma or principle of coma (hepatic encephalopathy) requires specific drugs, reducing the intake of proteins and control of gastrointestinal bleeding.

• Treatment of bleeding from esophageal varices include endoscopic ligation or sclerotherapy as (direct injection of a chemical that destroys the varix inside) and other treatments such as medications that decrease the tendency to bleed, compression of a bleeding varix through special inflatable balls and a procedure called transjugular intrahepatic protosystem shunt (TIPS).

HOW I CAN I PREVENT CIRRHOSIS?

• Do not drink to excess. Avoid alcoholic beverages. Alcohol destroys liver cells. The degree of regeneration of liver cells varies from person to person. Prior damage to the liver for unknown viruses or chemicals can affect the regeneration process.

• Eat a balanced diet, maintain a healthy weight and do regular physical activity.

• Seek medical help. Keep under medical care if you develop viral hepatitis until his recovery is assured.

The liver is large, with large functional reserve, able to continue to play its vital functions even if it is damaged. It also has the ability to repair itself to some degree. The cells that die can be replaced with new ones. If the cause of cirrhosis can be eliminated or controlled, the liver's ability allows it to achieve some improvement and may allow play a normal life.

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Korsakoff's syndrome (also called Korsakoff's dementia, Korsakov's syndrome, Korsakoff's psychosis, or amnesic-confabulatory syndrome), is a neurological disorder caused by the lack of thiamine (vitamin B1) in the brain. Its onset is linked to chronic alcohol abuse and/or severe malnutrition. The syndrome is named after Sergei Korsakoff, the neuropsychiatrist who popularized the theory.

CAUSES

Conditions resulting in the vitamin deficiency and its effects include chronic alcoholism and severe malnutrition. Alcoholism may be an indicator of poor nutrition, which in addition to inflammation of the stomach lining, causes thiamine deficiency. Other causes include dietary deficiencies, prolonged vomiting, eating disorders, or the effects of chemotherapy. It can also occur in pregnant women who have a form of extreme morning sickness known as hyperemesis gravidarum. Mercury poisoning can also lead to Korsakoff's syndrome. It has also been caused by centipede (mukade) bites in Japan.

There is no specific treatment because the previous thiamine deficiency produces irreversible damage to the medial thalamic nuclei and mammillary bodies. Mammillary body atrophy may be visible on high-resolution MRI.

SYMPTOMS

There are six major symptoms of Korsakoff's syndrome:

anterograde amnesia. retrograde amnesia, severe memory loss. confabulation, that is, invented memories which

are then taken as true due to gaps in memory sometimes associated with blackouts.

meager content in conversation. lack of insight. apathy - the patients lose interest in things

quickly and generally appear indifferent to change.

These symptoms are caused by a deficiency of thiamine (vitamin B1), which is thought to cause damage to the medial thalamus and possibly to the mammillary bodies of the hypothalamus as well as generalized cerebral atrophy.When Wernicke's encephalopathy accompanies Korsakoff's syndrome, the combination is called the Wernicke-Korsakoff syndrome. Korsakoff's is a continuum of

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KORSAKOFF´S SYNDROME

Wernicke's encephalopathy, though a recognised episode of Wernicke's is not always obvious.

Korsakoff's involves neuronal loss, that is, damage to neurons; gliosis which is a result of damage to supporting cells of the central nervous system; and hemorrhage or bleeding in mammillary bodies. Damage to the dorsomedial nucleus or anterior group of the thalamus (limbic-specific nuclei) is also associated with this disorder.

SIGNS

Apathy. Ataxia. Coma. Confabulation. Paralysis of muscles controlling the eye. Retrograde and anterograde amnesia. Tremor. Anosognosia - Lack of insight to or awareness of the condition.

TREATMENT

It was once assumed that anyone suffering from Korsakoff's syndrome would eventually need full time care. This is still often the case, but rehabilitation can help regain some, often limited, level of independence. Treatment involves the replacement or supplementation of thiamine by intravenous (IV) or intramuscular (IM) injection, together with proper nutrition and hydration. However, the amnesia and brain damage caused by the disease does not always respond to thiamine replacement therapy. In some cases, drug therapy is recommended. If treatment is successful, improvement will become apparent within two years although recovery is slow and often incomplete.

PREVENTION

The most effective method of preventing Korsakoff's syndrome is to avoid B vitamin/thiamine deficiency. In Western nations, the most common causes of such a deficiency are alcoholism and weight disorders. In the U.S., government mandates to adding thiamine to alcoholic beverages have been blocked for this reason and also by political groups asserting that such supplementation would encourage alcohol use.

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