In reviewing the health record, one should pay particular attention to time and frequency patterns of injuries and illness particularly during and after holidays, weekends, or Monday mornings. Unexplained injuries, bruises, contusions, and episodes of gastritis or GI upsets are particularly valuable indicators. Attention should be paid to psychiatric consultation, notes of injury to family members, depressive reactions, or any history of family discord. The patient's service record can also supply further information about the alcoholic's deterioration by shedding light on such things as letters of indebtedness, letters of reprimand, humanitarian transfer, or having to be Medically Evacuated from an overseas billet. The physical findings in the early stages of alcoholism or alcohol abuse may be nonexistent or minimal.
Advanced alcoholism has significant physical findings depending on the degree of deterioration.
The patient will show involvement in one or all organ systems. Like syphilis and tuberculosis in the past, alcoholism has become a great imitator of other disease processes. The vital signs may reveal a rapid pulse, sometimes with extra beats and hypertension. The patient may show additional signs of withdrawal such as cool skin or diaphoresis. In advanced cases, a general examination may show varying degrees ofjaundice with spider angioma, multiple recent bruises, or healed injuries for which there are no good explanations.