Biochemistry

Question 1

How can you tell if someone is a chronic drinker from a blood test?

Answer 1

Raised GGT - LFT test
Increased mean cell volume
Raised triglycerides
More immature retinoblasts

Question 2

Why is GGT raised by chronic alcohol use

Answer 2

Ethanol induces the P450 oxygenase enzyme to break it down and this will raise GGT

Question 3

Why are triglycerides raised in chronic alcoholism

Answer 3

Increased synthesis of triglycerides in the level

Question 4

What Is the normal level of triglycerides and what will it go up to in alcoholics

Answer 4

Should be between 2 and 3

In alcoholics it can rise to very high numbers, even 3 figures

Question 5

Describe the effect of alcohol on major organs - liver, pancreas, muscles etc

Answer 5

Damages the liver
Effects how you metabolise glucose and can even lead to hypoglycaemia and coma
Damages pancreas - chronic alcoholics may present with acute or chronic pancreatitis
Toxic to muscles
May lead to alcoholic cardiomyopathy and heart failure

Question 6

How do you determine how severe the unconscious state is

Answer 6

Use the Glasgow coma scale

Question 7

How do you work out if a coma is caused by alcohol

Answer 7

Measure their serum osmolarity

An alcohol patient would have a large osmalol gap as the alcohol is affecting the levels

Question 8

How do you calculate serum osmolarity

Answer 8

Measure the concentration of electrolytes in the serum
Na is always highest
Double the level of sodium and add 10

Question 9

What is an osmalol gap

Answer 9

When there is a difference between the measured serum osmolarity and the one calculated from electrolyte levels
Seen in alcohol patients as electrolytes normal but osmolarity high

Question 10

How can ABG’s be used to determine what alcohol has been consumed

Answer 10

If it is methanol or ethylene glycol then the bicarb will be very low
This is because both get metabolised to incredibly acidic compounds and create a huge acid load which messes up the balance

Question 11

What type of patients will have methanol or ethylene glycol poisoning

Answer 11

Severe alcoholics
Suicidal people - drinking de-icer
Children - accidental

Question 12

Describe ALT

Answer 12

Alanine aminotransferase
Found especially in the liver - in hepatocytes
Tells you about liver damage

Question 13

What causes jaundice

Answer 13

Raised bilirubin

This can be caused by anything that increases haemolysis or a block in bile drainage

Question 14

What is the difference between unconjugated and conjugated jaundice

Answer 14

Unconjugated - bilirubin hasn’t gone through the liver (prehepatic)
Conjugated - post-hepatic so caused by issue after the liver like blocked duct or tumour
Liver disease can cause both types

Question 15

Describe ALP

Answer 15

Alkaline phosphate
Found in both the liver and bone
Also is proximal tubules of kidneys and small intestine

Question 16

How do you determine whether raised ALP is from the liver or bone

Answer 16

Measure GGT at the same time

If it is also raised it is more likely to be liver

Question 17

Describe albumin

Answer 17

Made in the liver
Marker of liver function
Can be affected by lots of thing so not as accurate

Question 18

How can you determine of abdominal pain is caused by alcohol

Answer 18

Do LFT’s to check liver and gall bladder

Do amylase to see if it’s a pancreatitis caused by alcohol

Question 19

What tests should you do if an alcoholic patient is vomiting

Answer 19

Measure U and E – creatinine will rise as they will lose fluid through vomit

LFT’s - check for liver damage
Amylase - check for pancreatitis
ABG - vomiting causes loss of H+ so end up with a metabolic alkalosis
Potassium will be low in severe vomitors

Question 20

What is a potential consequence of repeated vomiting

Answer 20

Mallory-Weiss tear

Alcohol can cause repeated vomiting that leads to oesophageal rupture

Question 21

What tests should you do for haematemesis

Answer 21

U&E - urea raised in upper GI bleed
Lactate - tells you how perfused the patient is
LFT
PTR - prothrombin time ratio

Question 22

What are some potential causes of haematemesis due to alcoholism

Answer 22

Gastritis, Mallory wises tear, peptic ulcer, oesophageal varices