Alcohol-Related Medical Complications

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Alcohol-Related Medical Complications

Fatty Liver and Liver Disease

With moderate drinking, the liver can process alcohol fairly safely.  However, heavy drinking overtaxes the liver resulting in serious consequences.  A liver clogged with fat causes liver cells to become less efficient at performing their necessary tasks, resulting in impairment of a person’s nutritional health.  Fatty liver is the first stage of liver deterioration in heavy drinkers, and interferes with the distribution of oxygen and nutrients to the liver’s cells.  If the condition persists long enough, the liver cells will die, forming fibrous scar tissue (the second stage of liver deterioration, or fibrosis).  Some liver cells can regenerate with good nutrition and abstinence, however in the last stage of deterioration, or cirrhosis, the damage to the liver cells is the least reversible.

Pancreatitis

The pancreas is a large gland located behind the stomach and next to the duodenum (the first section of the small intestine). The pancreas has two primary functions:

  1. To secrete powerful digestive enzymes into the small intestine to aid the digestion of carbohydrates, proteins, and fat.
  2. To release the hormones insulin and glucagon into the bloodstream. These hormones are involved in blood glucose metabolism, regulating how the body stores and uses food for energy.

Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage occurs when the digestive enzymes are activated before they are secreted into the duodenum and begin attacking the pancreas.

There are two forms of pancreatitis: acute and chronic.

Acute pancreatitis is a sudden inflammation that occurs over a short period of time. In the majority of cases, acute pancreatitis is caused by gallstones or heavy alcohol use. Other causes include medications, infections, trauma, metabolic disorders, and surgery. In about 10% to 15% of people with acute pancreatitis, the cause is unknown.

The severity of acute pancreatitis may range from mild abdominal discomfort to a severe, life-threatening illness. However, the majority of people with acute pancreatitis (more than 80%) recover completely after receiving the appropriate treatment.

Chronic pancreatitis occurs most commonly after an episode of acute pancreatitis and is the result of ongoing inflammation of the pancreas.

In about 45% of people, chronic pancreatitis is caused by prolonged alcohol use. Other causes include gallstones, hereditary disorders of the pancreas, cystic fibrosis, high triglycerides, and certain medicines. Damage to the pancreas from excessive alcohol use may not cause symptoms for many years, but then the person may suddenly develop severe pancreatitis symptoms, including severe pain and loss of pancreatic function, resulting in digestion and blood sugar abnormalities.

Treatment for Pancreatitis

People with acute pancreatitis are primarily treated with intravenous fluids and pain medications in the hospital. In up to 20% of people, the pancreatitis can be severe and require admission to an intensive care unit (ICU). In the ICU, the person is closely monitored, since pancreatitis can cause damage to the heart, lungs, or kidneys. Some cases of severe pancreatitis can result in death of pancreatic tissue (pancreatic necrosis). In these cases, surgery may be necessary to remove the damaged tissue if a secondary infection develops.

Chronic pancreatitis can be somewhat difficult to treat. Doctors will try to relieve pain and improve the nutritional and metabolic problems that result from loss of pancreatic function. People are generally given pancreatic enzymes or insulin, if these substances are not being secreted or released by the pancreas. Pancreatic enzyme pills are usually prescribed to be taken with meals to aid in nutrient absorption. A low-fat diet may also be helpful.

Surgery may help relieve abdominal pain, restore drainage of pancreatic secretions, treat chronic pancreatitis caused by blockage of the pancreatic duct, or reduce the frequency of attacks.

People must stop drinking alcoholic beverages, follow their doctor and dietitian's dietary recommendations, and take the proper medications in order to have fewer and milder attacks of pancreatitis.

Esophageal Varices

Bleeding esophageal varices are enlarged veins in the walls of the lower part of the esophagus (the tube that connects the throat to the stomach) that bleed.

Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring reduces blood flowing through the liver. As a result, more blood flows through the veins of the esophagus. This extra blood flow causes the veins in the esophagus to balloon outward. If these veins break open, they can bleed severely. Any type of chronic liver disease can cause esophageal varices.

People with chronic liver disease and esophageal varices may have no symptoms. If there is only a small amount of bleeding, the only symptom may be dark or black streaks in the stools.

If larger amounts of bleeding occur, symptoms may include:

The goal of treatment is to stop acute bleeding as soon as possible, and treat varices with medicines and medical procedures. Bleeding must be controlled quickly to prevent shock and death. If massive bleeding occurs, the person may be placed on a ventilator to protect the airways and prevent blood from going down into the lungs.

Treating the causes of liver disease may prevent future bleeding. Preventive treatment of varices includes medications such as beta blockers or endoscopic banding. Bleeding often comes back without treatment.

Bleeding esophageal varices are a serious complication of liver disease and have a poor outcome. Liver transplantation may be considered for some patients.

Wet Brain

Wet brain is a form of brain damage and is also called Wernicke-Korsakoff syndrome. It is caused by a deficiency of thiamine (vitamin B1) as alcohol interferes with the absorption of thiamine. It has a sudden onset and is caused by a large dose of glucose as thiamine is essential for the metabolism of glucose.  It is very dangerous for malnourished drinkers to eat sweets and no vitamins or nourishing food.

If the Wernicke's encephalopathy goes untreated, it will progress to the second stage of wet brain, which is known as Korsakoff's psychosis, which is not reversible.

Anyone who drinks alcohol should always try to eat well and be careful to take vitamins. Very heavy drinkers may always feel too nauseous to eat much and they or their loved ones should at least try to make sure they get adequate vitamin supplements, particularly thiamine (B1).  When malnourished heavy drinkers show up for medical treatment, doctors should be sure to give them vitamin shots or an IV with thiamine.  Heavy drinkers need to be careful to get much more thiamine in their diets than non-drinkers because heavy drinking prevents much of the thiamine from being absorbed.

Symptoms of wet brain:

  • Staggering, irregular gait, and poor muscle coordination
  • Confabulation (remembering events that never happened)
  • Inability to form new memories
  • Loss of memory (this can be severe)
  • Visual and auditory hallucinations
  • Vision changes (including double vision, eyelid drooping, and abnormal eye movements)

What is "Kindling"?

Some people who have repeatedly gone through “cold turkey” withdrawal without tapering off become more and more likely to have bad withdrawals from even small amounts of alcohol.  This phenomenon is referred to as “kindling”.  People who have undergone kindling can suffer withdrawal seizures from drinking as little as a six-pack of beer.

Alcohol Poisoning and Alcohol Blackouts

Alcohol poisoning occurs when a large amount of alcohol is consumed, usually over a short period of time.  The blood alcohol level is so high, it is considered toxic (poisonous).  The person can become extremely confused, unresponsive, disoriented, have shallow breathing, pass out, or even go into a coma.  Alcohol poisoning can be life-threatening and requires urgent medical treatment.

Alcohol blackouts generally occur when alcohol in the bloodstream spikes too high and too rapidly, exposing the brain to a sudden spike in blood alcohol content (BAC).

Some people have a much higher likelihood of experiencing alcoholic blackouts.  These include people who have had gastric bypass surgery, people with long histories of severe alcohol abuse and withdrawal, and people with genetic irregularities in their alcohol metabolism.

Strategies to Prevent Blackouts

Eat – Eating a meal causes the valve between the stomach and the intestine to close for several hours, which greatly slows the influx of alcohol into the bloodstream and prevents BAC spikes.

Hydrate – Drinking a lot of water before consuming alcohol will reduce thirst helping one to drink more slowly and not spike the BAC.

Pace – Slow down drinking speed.  One way to do this is to alternate non-alcoholic drinks with alcoholic drinks.  Another technique is to time drinks with a watch.

Weaker Drinks – Avoid drinking straight shots of alcohol.  As a general rule, the weaker the drink, the longer it will take to drink.  Drinks that have taste often take longer to drink than tasteless ones.  For example, most people will drink a gin martini more slowly than a vodka martini.

Rest – Many people have blackouts if they drink alcohol when they are sleep deprived. Being well rested before drinking will help avoid having blackouts.

Environment – Drinking in a strange environment can reduce tolerance to alcohol and increase the likelihood of blackouts.

Don't Mix Alcohol and Meds – Many medications can greatly increase the chance of blackouts if mixed with alcohol.  Some are life-threatening.  Medications that commonly lead to blackouts when mixed with alcohol include narcotic painkillers such as codeine, non-narcotic painkillers like aspirin, and nearly all sleep aids including antihistamines like Benadryl, and prescription sleep aids like Ambien.

Avoid Drinking Games – Drinking games or beer bongs can spike the BAC very quickly.

 

 

 

 

 

 

 


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