HYPERTENSION

DEFINITION:
Hypertension, also referred to as high blood pressure, is a condition in which the arteries have persistently elevated blood pressure. Every time the human heart beats, it pumps blood to the whole body through the arteries. Blood pressure is the force of blood pushing up against the blood vessel walls. The higher the pressure the harder the heart has to pump. Hypertension can lead to damaged organs, as well as several illnesses, such as renal failure (kidney failure), aneurysm, heart failure, stroke, or heart attack. Sign and Symptoms: There is no guarantee that a person with hypertension will present any symptoms of the condition. Extremely high blood pressure may lead to some symptoms, however, and these include:

Severe headaches Fatigue or confusion Dizziness Nausea Problems with vision Chest pains Breathing problems Irregular heartbeat Blood in the urine

MANAGEMENT:
The main goal of treatment for hypertension is to lower blood pressure to less than 140/90 - or even lower in some groups such as people with diabetes, and people with chronic kidney diseases. Treating hypertension is important for reducing the risk of stroke, heart attack, and heart failure. High blood pressure may be treated medically, by changing lifestyle factors, or a combination of the two. Important lifestyle changes include losing weight, quitting smoking, eating a healthful diet, reducing sodium intake, exercising regularly, and limiting alcohol consumption. Medical options to treat hypertension include several classes of drugs. ACE inhibitors, ARB drugs, beta-blockers, diuretics, *calcium channel blockers, alpha-blockers, and peripheral vasodilators are the primary drugs used in treatment. These medications may be used alone or in combination, and some are only used in combination. In addition, some of these drugs are preferred to others depending on the characteristics of the patient (diabetic, pregnant, etc.).

*Calcium-channel blockers and cancer risk - postmenopausal females who took calciumchannel blockers for 10 years were found to be 2.5 times more likely to develop breast cancercompared to women who never took them or those on other hypertension medications. If blood pressure is successfully lowered, it is wise to have frequent checkups and to take preventive measures to avoid a relapse of hypertension.

NUTRITION/DIET:
1. Reduce sodium diet. 2. Eat less processed foods. 3. Use herbs instead of salts. 4. Red Rice, brown rice or the darker one is very recommended. 5. Limit amount of Alcohol. 6. Less Carbohydrate in meals. 7. More fruits and vegetables. 8. Limit fat intake and meats and dairy products. 9. Drink non-fat Milk. 10. Substitute meat by Tokwa. 11. Use Olive oil instead of ordinary Lard. 12. High in fiber foods and high in potassium such as banana, potatoes etc 13. Avoid sweets use artificial sweetener instead of ordinary sugar. 14. Avoid soda, coffee or any caffeinated drinks.

DIABETES MELLITUS
DEFINITION:
Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).

SIGN AND SYMPTOMS:

1. 2. 3. 4. 5. 6. 7. Weight Loss Polyuria or frequent urination Polydipsia or increased thirst Polyphagia or increased hunger. Increased blood glucose. Blurred vision. Impaired healing of the wounds.

MANAGEMENT:
Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal ("euglycemia") as possible, without causing hypoglycemia. This can usually be accomplished with diet, exercise, and use of appropriate medications such as insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin, in type 2 diabetes. Metformin is generally recommended as a first line treatment for type 2 diabetes, as there is good evidence that it decreases mortality.Routine use of aspirin, however, has not been found to improve outcomes in uncomplicated diabetes.

NUTRITION/DIET:
1. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts. 2. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts. 3. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts. 4. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts.

5. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts. 6. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts. 7. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts. 8. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts. A friendly Diet for diabetes: Hold the bread (or rice or pasta) if you want dessert. Eating sweets at a meal adds extra carbohydrates. Because of this it is best to cut back on the other carb-containing foods at the same meal. Add some healthy fat to your dessert. It may seem counterintuitive to pass over the low-fat or fat-free desserts in favor of their higher-fat counterparts. But fat slows down the digestive process, meaning blood sugar levels dont spike as quickly. That doesnt mean, however, that you should reach for the donuts. Think healthy fats, such as peanut butter, ricotta cheese, yogurt, or some nuts. Eat sweets with a meal, rather than as a stand-alone snack. When eaten on their own, sweets and desserts cause your blood sugar to spike. But if you eat them along with other healthy foods as part of your meal, your blood sugar wont rise as rapidly. When you eat dessert, truly savor each bite. How many times have you mindlessly eaten your way through a bag of cookies or a huge piece of cake. Can you really say that you enjoyed each bite? Make your indulgence count by eating slowly and paying attention to the flavors and textures. Youll enjoy it more, plus youre less likely to overeat. Tricks for cutting down on sugar: Reduce how much soft drinks, soda and juice you drink. A recent study found that for each 12 oz. serving of a sugar-sweetened beverage you drink a day, your risk for diabetes increases by about 15 percent. If you miss your carbonation kick, try sparkling water with a twist of lemon or lime or a splash of fruit juice. Reduce the amount of creamers and sweeteners you add to tea and coffee drinks. Sweeten foods yourself. Buy unsweetened iced tea, plain yogurt, or unflavored oatmeal, for example, and add sweetener (or fruit) yourself. Youre likely to add far less sugar than the manufacturer would have.

Reduce the amount of sugar in recipes by to . If a recipe calls for 1 cup of sugar, for example, use or cup instead. You can also boost sweetness with cinnamon, nutmeg, or vanilla extract. Find healthy ways to satisfy your sweet tooth. Instead of ice cream, blend up frozen bananas for a creamy, frozen treat. Or enjoy a small chunk of dark chocolate, rather than your usual milk chocolate bar. Start with half of the dessert you normally eat, and replace the other half with fruit.

GASTROENTERITIS
DEFINITION:
Gastroenteritis is an infection of the gut. It causes diarrhoea, and may also cause vomiting, abdominal pain and other symptoms. In most cases the infection clears over several days, but sometimes takes longer.

SIGNS AND SYMPTOMS:

The main symptom is diarrhea, often with vomiting as well. Diarrhea means loose or watery stools (faeces), usually at least three times in 24 hours. Blood or mucus can appear in the stools with some infections. Crampy pains in your abdomen (tummy) are common. Pains may ease for a while each time you pass some diarrhea. A high temperature (fever), headache and aching limbs sometimes occur.

If vomiting occurs, it often lasts only a day or so, but sometimes longer. Diarrhea often continues after the vomiting stops and commonly lasts for several days or more. Slightly loose stools may persist for a week or so further before a normal pattern returns. Sometimes the symptoms last longer. Symptoms of dehydration: Diarrhea and vomiting may cause dehydration (a lack of fluid in the body). Consult a doctor quickly if you suspect you are becoming dehydrated. Mild dehydration is common and is usually easily reversed by drinking lots of fluids. Severe dehydration can be fatal unless quickly treated because the organs of your body need a certain amount of fluid to function.

Symptoms of dehydration in adults include: tiredness, dizziness or light-headedness, headache, muscular cramps, sunken eyes, passing little urine, a dry mouth and tongue, weakness, and becoming irritable. Symptoms of severe dehydration in adults include: weakness, confusion, rapid heart rate, coma, and producing very little urine. Severe dehydration is a medical emergency and immediate medical attention is needed.

Dehydration in adults with gastroenteritis is more likely to occur in:

Elderly or frail people. Pregnant women. People with severe diarrhea and vomiting. In particular, if you are not able to replace the fluid lost with enough drinks.

MANAGEMENT:
1. Fluids - have lots to drink. The aim is to prevent dehydration, or to treat dehydration if it has developed. 2. Rehydration drinks are recommended for people who are frail, or over the age of 60, or who have underlying health problems. They are made from sachets that you can buy from pharmacies. 3. Anti-secretory medicines are designed to be used with rehydration treatment. They reduce the amount of water that is released into the gut during an episode of diarrhea. 4. Eat as normally as possible. It used to be advised to not eat for a while if you had gastroenteritis. However, now it is advised to eat small, light meals if you can. Be guided by your appetite. You may not feel like food and most adults can do without food for a few days. Eat as soon as you are able - but don't stop drinking. If you do feel like eating, avoid fatty, spicy or heavy food at first. Plain foods such as wholemeal bread and rice are good foods to try eating first. 5. Medication. Antidiarrheal medicines are not usually necessary. However, you may wish to reduce the number of trips that you need to make to the toilet. You can buy antidiarrhoeal medicines from pharmacies. The safest and most effective is loperamide. The adult dose of this is two capsules at first. This is followed by one capsule after each time you pass some diarrhoea up to a maximum of eight capsules in 24 hours. It works by slowing down your gut's activity. You should not take loperamide for longer than five days. Antibiotic medicine as prescribed. 6. For fever. Paracetamol or ibuprofen is useful to ease a high temperature or headache. 7. Prevent spead of Infection: a. Wash your hands thoroughly after going to the toilet. Ideally, use liquid soap in warm running water, but any soap is better than none. Dry properly after washing. b. Don't share towels and flannels. c. Don't prepare or serve food for others. d. Regularly clean the toilets that you use, with disinfectant. Wipe the flush handle, toilet seat, bathroom taps, surfaces and door handles with hot water and detergent at least once a day. Keep a cloth just for cleaning the toilet (or use a disposable one each time). e. Stay off work, college, etc, until until at least 48 hours after the last episode of diarrhoea or vomiting. f. Food handlers: if you work with food and develop diarrhoea or vomiting, you must immediately leave the food-handling area. For most, no other measures are needed, other than staying away from work until at least 48 hours after the last episode of diarrhoea or vomiting. Some special situations may arise and sometimes longer time off is needed. Specialist advice may be needed for some uncommon causes of gastroenteritis. If in doubt, seek advice from your employer or GP.

g. If the cause of gastroenteritis is known to be (or suspected to be) a microbe called Cryptosporidium spp., you should not swim in swimming pools for two weeks after the last episode of diarrhoea.

NUTRITION/DIET:
1. Drink fluids such as GATORADE (or any other sports drink), broth, tea, flat soda or tonic, clear fruit juices such as apple juice or eat Jello. Wait at least 30 minutes after vomiting and then start fluids in small, frequent sips. 2. White toast, crackers and dry cereal (not whole grain) 3. Rice, pasta or potato (without margarine, butter, oil, or sauce) 4. Bananas, applesauce 5. Baked, broiled or boiled lean meat (chicken, turkey, fish, beef. 6. It is important that you have several small meals spaced throughout the day rather than three large meals. 7. You may begin to eat small amounts of cooked vegetables, fruits and juices, skim or low fat milk products. 8. It is helpful to avoid fried foods, uncooked fruits or vegetables, whole milk products, large amounts of butter, margarine, cooking oils or cream until your bowel rebuilds its protective lining.

LIVER CIRRHOSIS
DEFINITION: Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver. SIGN AND SYMPTOMS: 1. 2. 3. 4. 5. 6. 7. 8. Loss of appetite Weight loss. Tiredness and weakness. Nausea. Ascites. Bruising and bleeding. Jaundice. Spider naevi.- These are dilated blood vessels in the skin with a spidery appearance. 9. Gallstones. 10. Reddening of the palms of the hands. 11. Enlarged breast tissue in men 12. Mental disturbances. 13. Sensitivity to medicines. 14. Varices.

MANAGEMENT: Because cirrhosis is irreversible, treatment aims to stop the disease from getting any worse. The treatment you are offered will depend on the cause of your cirrhosis. 1. If cirrhosis is caused by viral hepatitis, may be treated with anti-viral drugs to reduce permanent damage. Treatment of hepatitis B and C in the early stages is increasingly successful at preventing cirrhosis. Autoimmune hepatitis may be treated with steroids or other medicines that supress the immune system. 2. Avoid alcohol. 3. Cirrhosis caused by Wilsons disease is treated with medications to remove the excess copper from the body. Similarly, cirrhosis caused by haemochromatosis is treated by letting blood every so often to use up the excess iron in the body. 4. Some symptoms of cirrhosis can be helped by medications. Ascites and fluid retention can be treated with medicines known as diuretics that help remove excess fluid. A lowsodium diet and restricting fluid intake can also help with these problems.

5. Medications may be given to help reduced mental functioning and your doctor may advise making changes to your diet to assist this process. Meals that are high in protein can often precipitate confusion known as hepatic encephalopathy in people with liver failure. Also, if itching is a symptom, your doctor will probably be able to prescribe something to help stop or reduce the itching. 6. If severe, liver transplant is the best way to do.

NUTRITION/DIET: 1. Avoid salty foods, salt in cooking, and salt at the table. Anything that tastes salty (such as tomato sauce, salsa, soy sauce, canned soups) probably has too much salt. Spice things up with lemon juice or herbs, instead of salt. Fresh foods usually are a better bet than processed foods. 2. Avoid fast-food restaurants. Most fast foods are very high in sodium. 3. Go easy on meats, especially red meats, which are high in sodium. When possible, consider vegetarian (meat-free) alternatives. 4. People with cirrhosis may need more extra calories and protein. 5. It can help to eat small, frequent meals (4 to 7 times a day), including an evening snack. Doctor even may recommend high-nutritional supplement drinks, such as Ensure or Boost.

IRON DEFICIENCY ANEMIA.

DEFINITION:
As the name implies, iron deficiency anemia is due to insufficient iron. Without enough iron, your body can't produce enough hemoglobin, a substance in red blood cells that enables them to carry oxygen. As a result, iron deficiency anemia may leave you tired and short of breath.

SIGN AND SYMPTOMS:

1. Extreme fatigue 2. Pale skin 3. Weakness 4. Shortness of breath 5. Headache 6. Dizziness or lightheadedness 7. Cold hands and feet 8. Irritability 9. Inflammation or soreness of your tongue 10. Brittle nails 11. Fast heartbeat 12. Unusual cravings for non-nutritive substances, such as ice, dirt or starch 13. Poor appetite, especially in infants and children with iron deficiency anemia 14. An uncomfortable tingling or crawling feeling in your legs (restless legs syndrome)

MANAGEMENT.
1 . Phycians may prescribed iron supplements. to replenish the iron stores in our body. To improve the chances that your body will absorb the iron in the tablets, you may be instructed to: Take iron tablets on an empty stomach. If possible, take iron tablets when stomach is empty. However, because iron tablets can upset stomach, may need to take iron tablets with meals. Take iron tablets with vitamin C. Vitamin C improves the absorption of iron. Doctor might recommend taking iron tablets with a glass of orange juice or with a vitamin C supplement.

2. Iron deficiency can't be corrected overnight. May need to take iron supplements for several months or longer to replenish iron reserves. 3. Treating underlying causes of iron deficiency: a. Medications, such as oral contraceptives to lighten heavy menstrual flow b. Antibiotics and other medications to treat peptic ulcers c. Surgery to remove a bleeding polyp, a tumor or a fibroid If iron deficiency anemia is severe, blood transfusions can help replace iron and hemoglobin quickly.

NUTRITION/DIET:
The following are recommended diet: 1. 2. 3. 4. 5. 6. 7. 8. 9. red meat poultry fish eggs dried beans and lentils green leafy vegetables nuts seeds wholegrain breads and cereals.

Absorption of iron from plant foods can be improved by eating food rich in vitamin c in the same meal. Try citrus fruits, red capsicum or kiwi fruit. Absorption of iron from plant foods can be inhibited by tea, coffee and cola drinks. It is best to have these drinks between meals.