Hypothesis
Abdominal pain can be caused by excessive consumption of alcohol. This pain can be acute or chronic and there are several possible causes. First, alcohol intake can cause irritation of the esophageal and stomach wall lining which then become inflamed leading to esophagitis and gastritis. It can also induce acid reflux and pain in upper gastrointestinal tract.
Acute and chronic pancreatitis can be as a direct effect of alcohol consumption. Liver diseases like alcoholic hepatitis and cirrhosis can also present with abdominal pain. These liver diseases can lead to portal hypertension with development of painful esophageal varices. Alcohol consumption predisposes to tumors of the gastrointestinal tract which then present with pain (Brick, 2008).
Medical interventions in alcoholics undergoing operation
Identifying an alcoholic
Disclosure of alcohol consumption before surgery is important as alcoholism directly affect the outcome of surgery. It is therefore important for the health professionals to enquire about this and put into place measures to ensure that risks associated with alcoholism are decreased. There are several tools that can be used for this purpose, which include questionnaires and laboratory investigations.
The CAGE question, Michigan Alcoholism Screening test and Alcohol Use Disorder identification test can be used to detect alcoholism in the patient. Laboratory tests such as carbohydrate-deficient transferring and gamma-glutamyltransferase can also be used. This information can be used for early diagnosis and correct management of alcohol withdrawal in the post-operative period (Martin et al, n.d).
Pre-operative interventions
After identifying an alcoholic, the health professional should institute measures to decrease intra-operative and post-operative complications associated with it. The need for abstinence and even cessation should be stressed to the patient. He/she should have weekly meetings with a health professional during which an assessment of alcohol consumption is done. The issue of withdrawal symptoms is discussed and a schedule of their treatment, as well as supportive medication, is formulated. The patient should be well informed on the benefits of withdrawal/cessation and the possible side effects (Tonnesen et al, 2009).
The patient should be informed about the effects of alcoholism on his/her body and how they affect the outcome of surgery. He/ she should be made aware of an increased risk of post-operative infections due to the effects of alcohol on the immune system. Alcohol also affects the clotting cascade therefore there would be an increased risk of excessive bleeding.
The risk of cardiopulmonary complications should also be explained to the patient. Alcohol can alter the metabolism of various drugs, hence narrowing the choice of drugs that can be used on the patient and this should be explained (Tonnesen et al, 2009).
The role of alcohol in the causation of the disease the patient is being operated for should be explained in cases where alcohol could have played a role, like in colon cancer. The possibility of recurrence should be mentioned and the need to stop alcohol consumption to prevent this stressed. Presence of end organ diseases related to alcohol should also be explained as they will affect morbidity after surgery (Polednak, 2007).
References
Brick, J. (2008), Handbook of the medical consequences of alcohol and drug abuse, New York: Haworth press.
Martin, M., Heymann, C., Neumann, T., Schmidt, L., Soost, F., mazurek, B., Bohm, B., Marks, C., Helling, K., Lenzenhuber, E., Muller, C., Kox, W. and Spies, C. (N. D), preoperative evaluation of chronic alcoholics assessed for surgery of the upper digestive tract. Alcoholism: Clinical and experimental research, 26, 6, 836; MD; Lippincott Williams & Wilkins Inc.
Polednak, A., (2007), Documentation of alcohol use in hospital records of newly diagnosed cancer patients: A populayion-based study. The American Journal of drug and Alcohol Abuse, 33, 3, 403-409.
Tonnesen, H., Lauritzen, J., Nielsen, P. and Moller, A., (2009), smoking and alcohol intervention before surgery: Evidence for best practice, British Journal of Anaesthesia, 102, 3, 297-306.