Alcohol Dependence: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
    • Inspection (viewing).
      • Skin, mucous membranes, pharynx (throat), and sclerae (white part of the eye) [tremor (shivering), sweating; withdrawal syndrome without delirium (state of confusion): facial flushing, mydriasis (dilated pupils), tremor (shivering)] [due topossible sequelae: pharyngitis (pharyngitis)]
      • Abdomen
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart [withdrawal syndrome without delirium (state of confusion): tachycardia (heartbeat too fast; > 100 heartbeats/min)][due topossible sequelae:
    • Examination of the lungs (due topossible sequelae):
      • Auscultation (listening) of the lungs [excitation stage (excitation stage) (1-2 ‰): hyperventilation (a lung ventilation/breathing increased above the need)]
      • Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the physician listens to the lungs)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g., in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in the case of decreased sound conduction (attenuated or absent: e.g., in pleural effusion). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
      • Voice fremitus (checking the transmission of low frequencies; the patient is asked to say the word “99” several times in a low voice, while the doctor puts his hands on the chest or back of the patient)[increased sound conduction due to pulmonary infiltration / compaction of lung tissue (eg, in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (greatly attenuated or absent: in pleural effusion). The consequence is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
    • Palpation (palpation) of the abdomen (abdomen) with an attempt to palpate the liver (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial ports?, kidney bearing knock pain?) [due topossible sequelae:
  • Cancer screening [due topossible secondary diseases:
    • Malignant tumors in the mouth, pharynx (throat) and esophagus (esophagus).
    • Bronchial carcinoma (lung cancer).
    • Hepatocellular carcinoma (liver cancer)
    • Colon carcinoma (colon cancer)
    • Gastric carcinoma (stomach cancer)
    • Mammary carcinoma (breast cancer) of the woman
    • Pancreatic carcinoma (pancreatic cancer)
    • Squamous cell carcinoma of the skin]
  • Dermatological examination [due topossible secondary diseases:
    • Skin aging
    • Nail psoriasis (nail psoriasis)
    • Pityriasis simplex capitis (dandruff of the head).
    • Psoriasis (psoriasis)
    • Rosacea (copper rose) – chronic inflammatory, non-contagious skin disease that manifests on the face; papules (nodules) and pustules (pustules) and telangiectasia (dilation of small, superficial skin vessels)] are typical.
  • Neurological examination [due topossible secondary diseases:
    • Cluster headache
    • Dementia
    • Diabetic polyneuropathy – chronic disorders of the peripheral nerves or parts of nerves in diabetes mellitus. These lead mainly to sensory disturbances in the affected areas of the body.
    • Epilepsy
    • Korsakoff syndrome (amnesic psychosyndrome) – a form of amnesia (memory impairment) first described in alcoholics.
    • Marchiafava-Bignami syndrome (synonym: corpus callosum atrophy) – rare neuropsychiatric disorder described, the cause of which has not yet been conclusively determined; occurs mainly as a result of chronic alcoholism in conjunction with malnutrition.
    • Migraine
    • Alzheimer’s disease
    • Obstructive sleep apnea syndrome – pauses in breathing during sleep caused by obstruction of the airway.
    • Polyneuropathy (nerve damage).
    • Pontine myelinolysis – damage to the central nervous system due to rapid compensation of hyponatremia (sodium deficiency).
    • Restless Legs Syndrome (RLS)
    • Somatoform disorders
    • Transient ischemic attack (TIA) – sudden onset neurologic disorder that resolves within 24 hours, making it the only distinction from apoplexy (stroke)
    • Wernicke’s encephalopathy (synonyms: Wernicke-Korsakow syndrome; Wernicke’s encephalopathy) – degenerative encephaloneuropathic disease of the brain in adulthood; clinical picture: brain-organic psychosyndrome (HOPS) with memory loss, psychosis, confusion, apathy, as well as gait and stance unsteadiness (cerebellar ataxia) and eye movement disorders/eye muscle paralysis (horizontal nystagmus, anisocoria, diplopia)); vitamin B1 deficiency (thiamine deficiency)]
  • Psychiatric examination [due topossible secondary diseases:
  • Urological examination [due topossible sequelae: Nephrolithiasis (kidney stones), urolithiasis (urinary stones)]
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.