Alcoholism - Chronic Complications
* Affects nearly every organ system:
- NEURO – Affects both peripheral nervous system (peripheral neuropathy) and central nervous sytem: Cognitive dysfunction, Cerebellar degeneration, Wernicke’s encephalopathy (acute reversible syndrome of psychosis, ophthalmoplegia, and ataxia) which can progress to Korsakoff syndrome (chronic, irreversible syndrome of memory loss and confabulation).
- CV – Hypertension, Dilated cardiomyopathy
- PULMONARY – none directly, but pts often develop pneumonia including aspiration. Also, suspect Klebsiella as a pathogen.
- GI – many manifestations, including esophagitis, gastritis, pancreatitis (acute and chronic), hepatitis/cirrhosis.
- HEME – Megaloblastic anemia from folate deficiency. Alcoholism can also cause mild macrocytosis independent of folate deficiency, due to a direct effect on the bone marrow (common: ~90% of alcoholics have MCV of 100-110 even before anemia develops. Abstinence results in resolution within 2-4 months). Leukopenia and Thrombocytopenia due to direct bone marrow effect, but also from cirrhosis/splenomegaly.
- ENDOCRINE – Cirrhosis leading to gynecomastia and testicular atrophy, amenorrhea/infertility. Alcohol can also cause hypoglycemia in alcoholics.
- ONCOLOGY – alcohol predisposes to multiple cancers, most notably Hepatocellular carcinoma (secondary to cirrhosis), also ENT and esophageal cancers (synergistic with smoking), as well as breast cancer and others.
- NUTRITIONAL – of course, can lead to Thiamine deficiency --> Wernicke/Korsakoff --> Dry and Wet Beriberi, Niacin deficiency --> Pellagra (diarrhea, dementia, dermatitis), Folate deficiency.
Of course, we are all well-aware of the acute complications of alcohol consumption, including intoxication, respiratory and CNS depression, and acute GI problems including pancreatitis and gastritis, and withdrawal syndromes (see below).
(Chanu Rhee MD, 11/11/10)