|
Alcoholism
remains a serious problem. Beyond the very serious consequences
of driving (and in rare instances flying) while intoxicated,
most of the 200,000 alcoholics who die annually in the U.S. die
from complications of alcoholic liver disease.
About 15 - 20 %
of individuals who drink more than 40 to 80 gms of ethanol a
day, for over 10 years, will develop cirrhosis. Some, mostly
women, will develop cirrhosis from drinking much less.
Alcoholism:
Concept
-
The World
Health Organization defines it as follows:
"Alcoholics are those excessive drinkers whose
dependence upon alcohol has reached such a degree that it
results in noticeable mental disturbance or in an
interference with their bodily and mental health, their
interpersonal relations, their smooth social and economic
functioning, or those who show the signs of such
developments." T
-
The American
Medical Association defines alcoholism as: An illness
characterized by significant impairment of physiological,
psychological or social functioning that is directly
associated with persistent and excessive alcohol use.
-
Others define
"an alcoholic" as: Anybody whose drinking has
seriously begun to interfere with one or more of the
following aspects of his life: [1.] Family life; [2.] Social
life; [3.] Legal life; [4.] Financial life; [5.]
Physical Health; [6.] Mental Health; [7.] Spiritual life,
and; [8.] Occupational life.
The fine line
between alcohol abuse and alcohol
dependence (alcoholism) is blurred and often
judgmental or circumstantial. Often it is much more prudent to
classify a diagnosis as alcohol dependence and afford the
individual the best chance at rehabilitation, as well as
recovery and preservation of life, family and career.
Alcoholism
& the various Forms of Liver Involvement:
The mildest
form of liver involvement is a fatty liver. Patients with
fatty liver are usually asymptomatic, although they may have
tender hepatomegaly.
Liver enzymes
and bilirubin are normal or only mildly elevated.
These patients
have an excellent prognosis if they abstain from alcohol. The
fatty changes are rapidly reversible once drinking is
discontinued.
Aviation
personnel should be grounded and treated aggresively for
alcohol dependance - The decision to return them to flying
duties is usually dependent on the success of their achieving
and maintaining sobriety. From an internal medicine
standpoint, they are qualified to resume flying if they have
normal hepatic function, as evidenced by normal liver enzymes,
bilirubin, albumin, prothrombin time, and CBC; and there
is no history or evidence of portal hypertension.
Alcoholic
hepatitis is a much more serious disorder characterized by
anorexia, nausea, vomiting, weight loss, abdominal pain, fever
and jaundice.
Portal
hypertension may cause ascites, spleenomegaly and bleeding
esophageal varicies.
Liver enzymes
are elevated five to 10 times normal, with SGOT being
significantly more elevated than SGPT.
Jaundice is
present at times accompanied by hypoalbuminemia, prolonged
prothrombin times and anemia.
Some patients
may progress to hepatic failure or hepatorenal syndrome.
Although some patients recover fully, most either continue to
have hepatitis or develop cirrhosis.
Cirrhosis
represents the end stage of alcoholic liver disease where the
liver has dense bands of connective tissue and areas of
micronodular regeneration.
Symptoms are
caused by hepatic dysfunction and portal hypertension.
|