最后审阅: 19 四月 2022
最后更新: 04 二月 2022

简介

疾病
描述

Problematic alcohol use is classified in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th ed., (DSM-5) as alcohol-use disorder, with severity specified as mild, moderate, or severe, depending on the number of diagnostic criteria that have been met;[2] and as harmful use of alcohol and alcohol dependence in the ICD-11[2][3] 酒精使用障碍是由遗传、社会心理和环境等多种因素导致的。[4] It is characterised by increased tolerance to the effects of alcohol, the presence of characteristic withdrawal signs and symptoms, and impaired control over the quantity and frequency of drinking.[2]

Alcohol withdrawal occurs in patients who are alcohol dependent and who have stopped or reduced their alcohol intake within hours or days of presentation. Symptoms typically begin 6 to 12 hours after the patient's last drink.[5][6] 常见症状包括焦虑、恶心或呕吐、自主神经功能障碍和失眠。 这些症状可进展为重度戒断,表现为痫样发作、精神障碍和震颤谵妄。[7][8][9]

Comprises three stages of liver damage: fatty liver (steatosis), alcoholic hepatitis (inflammation and necrosis), and alcoholic liver cirrhosis (fibrosis). All are caused by chronic heavy alcohol ingestion. Clinical presentation is highly variable. There is no specific laboratory test to identify alcohol as a cause of liver damage.

The pathological end stage of any chronic liver disease. The most common causes of cirrhosis in the Western world are alcohol-related liver disease, non-alcoholic fatty liver disease (NAFLD and associated steatohepatitis), and chronic viral hepatitis.[10][11][12] The main complications of cirrhosis are related to the development of liver insufficiency and portal hypertension, and include ascites, variceal haemorrhage, jaundice, portosystemic encephalopathy, acute kidney injury and hepatopulmonary syndromes, and the development of hepatocellular carcinoma.

这个综合征罕见,是指肝功能的快速下降,特征性表现是既往没有肝病的患者出现黄疸、凝血功能异常(INR大于1.5),以及肝性脑病。[13][14][15] Chronic alcohol misuse is a significant risk factor for the development of ALF.

A brain dysfunction caused by liver insufficiency and/or portosystemic shunt. It manifests as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma.[16] 研究者认为,肝性脑病是多因素造成的,这些因素造成氨通过门体分流而绕过肝脏,从而使脑组织暴露于氨。

A disorder of the exocrine pancreas and associated with acinar cell injury with local and systemic inflammatory responses.[17] 最常见的首发症状是中上腹或左上腹疼痛,放射至背部。上腹部压痛是典型体征。 酒精引起的急性胰腺炎占了40%~45%,是男性急性胰腺炎最常见的原因。 酒精诱发急性胰腺炎没有阈值。急性胰腺炎患者的日平均饮酒量是 150-175 g。[18][19]

表现为反复或持续性腹痛,胰腺及周边组织进行性损伤,导致瘢痕形成和功能丧失。 与反复发作的急性胰腺炎不同,慢性胰腺炎是以胰腺外分泌部功能下降,营养吸收障碍,糖尿病和胰腺钙化为特征。 在世界范围内,酒精是慢性胰腺炎的主要危险因素(70%~80%)。 酒精性胰腺炎发作需要协同因素共同作用,包括解剖结构异常、环境因素和/或遗传因素等,因此仅极少数长期酒精依赖者会发生慢性胰腺炎(不超过 10%,甚至可能低于 <3%)。[20][21][22]

A neurological emergency resulting from thiamine deficiency with varied neurocognitive manifestations, typically involving mental status changes and gait and oculomotor dysfunction. In people with chronic alcohol dependence, thiamine deficiency is a result of a combination of factors: poor intake, low content of vitamins in alcohol, low storage capacity of the liver, decreased intestinal absorption, impaired conversion of thiamine to its active form (thiamine pyrophosphate), and increased demand to metabolise the carbohydrates in alcohol.[23]

Refers to a group of conditions that may result from fetal exposure to alcohol.[24] Disorders include fetal alcohol syndrome (FAS), partial FAS, alcohol-related neurodevelopmental disorder, and alcohol-related birth defects. FAS is characterised by antenatal and postnatal growth retardation, specific facial dysmorphology and structural and/or functional abnormalities of the central nervous system.

Assessment of patients with abnormal liver tests should be guided by history, risk for liver disease, duration and severity of clinical findings, presence of comorbidities, and the nature of the liver test abnormality noted. Chronic alcoholic liver disease and acute alcoholic hepatitis are associated with elevation of serum aminotransferases.[25] Elevated gamma-GT correlates with excessive alcohol consumption; however, isolated elevations in gamma-GT are so common, and so often unhelpful, that many institutions have chosen to delete this test from their liver test panel.

谵妄是精神状态的一种急性波动性变化,有注意力不集中,思维紊乱和意识状态的改变。[26] Alcohol intoxication and withdrawal are frequently associated with delirium. Recent binge drinking can cause alcoholic ketoacidosis.

Polyneuropathy is a generalised disease of the peripheral nerves due to damage to the axon and/or the myelin sheath. It most commonly presents as symmetric numbness, paraesthesias, and dysaesthesias in the feet and distal lower extremities (distal symmetrical sensorimotor polyneuropathy). In severe cases, sensory symptoms and signs progress proximally to fit a stocking-glove distribution. Balance and gait may be impaired. Thiamine and pyridoxine deficiencies caused by alcoholism are possible causes of polyneuropathy. Ethanol-polyneuropathy, associated with alcohol-use disorder, may be caused by direct toxicity of ethanol on the nerve and/or concomitant nutritional deficiencies.

Upper gastrointestinal bleeding refers to gastrointestinal blood loss whose origin is proximal to the ligament of Treitz at the duodenojejunal junction. Causes are multiple, but in developed countries bleeding is usually secondary to peptic ulcer disease, erosions, oesophagitis, or varices. Any history of chronic and excessive alcohol use, intravenous drug use (or other behaviour that places people at risk of contracting hepatitis), or underlying liver disease strongly suggests a variceal bleed.

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BMJ Publishing Group

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