HEALTH EDUCATION

ON
LIVER CIRRHOSIS
STROKE
RHEUMATIC HEART
DISEASE
MYOCARDIAL INFARCTION
DIABETIS MELLITUS
DEPARTMENT OF LABOR
AND EMPLOYMENT
2
ND
BATCH
(July 9-Augus!"2##$%
C&'&()( C(s&ll*
N+,+l&-( C(s'*
M('y A.. C(*l*s
F'(./l&. D+)+.(
LIVER CIRRHOSIS
Cirrhosis is scarring of the
liver that involves the
formation of fibrous (scar)
tissue associated with the
destruction of the normal
architecture of the organ. It
is the result of long-
standing injury most
commonly due to alcohol in
excess but there are a
number of other important
causes0
Sy,1*,s
Many people with cirrhosis
have no symptoms in the
early stages of the disease.
owever! as scar tissue
replaces healthy cells! liver
function starts to fail and a
person may experience the
following symptoms"
#xhaustion
fatigue
loss of appetite
nausea
wea$ness
weight loss
abdominal pain
spider-li$e blood
vessels (spider
angiomas) that
develop on the s$in
C*,1l&)(&*.s *2
C&''3*s&s
#dema and ascites.
%ruising and
bleeding.
&aundice.
Itching
'allstones.
(oxins in the blood
or brain.
)ensitivity to
medication
*ortal hypertension.
+arices
Insulin resistance
and type , diabetes.
-iver cancer
43( )(us+s )&''3*s&s5
.lcohol excess
Chronic viral
hepatitis
*rimary biliary
cirrhosis
.utoimmune
chronic active
hepatitis
/rugs and
chemicals
Metabolic and inherited
disorders
43* &s ( '&s/5
(he more alcohol a person
drin$s! the more li$ely they
are to develop cirrhosis.
0omen seem to be more
susceptible than men. It is
therefore advisable to
restrict alcohol
consumption to ,1 units a
wee$ for men and ,2 units
a wee$ for women (a unit
of alcohol is a single
measure of spirits! a half
pint of ordinary beer or
lager or a standard si3e
glass of wine).
*atients who have ongoing
infection with hepatitis % or
hepatitis C virus.
*atients with primary
biliary cirrhosis or
autoimmune chronic active
hepatitis.
*atients with metabolic or
inherited disorders.
How can cirrhosis of the
liver be prevented?
-imit the inta$e of alcohol
(see above).
.lcoholics should see$
help.
*recautions should be ta$en
to avoid getting hepatitis
and if it is contracted it is
important that it is treated.
.void contact with toxic
chemicals at wor$.
How is cirrhosis of the
liver treated?
.part from removing the cause!
cirrhosis of the liver cannot be
treated. (he emphasis is
therefore on dealing with and
reducing the complications of
the disease.
(he following approaches are
used"
water tablets (diuretics) for
the treatment of fluid
retention in the legs
(oedema) or abdomen
(ascites).
vitamins and mineral
supplements.
calorie supplements
(usually sugar-based
drin$s) to maintain
nutrition.
laxatives (usually a syrupy
solution called lactulose) to
prevent constipation and to
reduce the chances of the
poisonous substances from
the bowel bypassing
the liver and
reaching the brain!
causing drowsiness!
confusion and coma
(hepatic
encephalopathy).
some patients who
have had bleeding
from ruptured
varicose veins in the
lower oesophagus
may be put onto a
drug called
propranolol! which
reduces the pressure
in those veins and
lowers the chances
of them bleeding
again.
finally! liver
transplantation may
be considered in
patients with end-
stage cirrhosis.
STROKE
. stro$e is serious - just
li$e a heart attac$. .
stro$e is sometimes
called a 4brain attac$.4
Most often! stro$e occurs
when blood flow to the
brain stops because it is
bloc$ed by a clot. (he
brain cells in the
immediate area begin to
die because they stop
getting the oxygen and
nutrients they need to
function.
43( )(us+s ( s'*/+5
(here are two $inds of
stro$e. (he most
common $ind of stro$e!
called ischemic stro$e! is
caused by a blood clot
that bloc$s or plugs a
blood vessel in the brain.
(he other $ind of stro$e!
called hemorrhagic
stro$e! is caused by a
blood vessel that brea$s
and bleeds into the brain.
43( 6&s(7&l&&+s )(.
'+sul 2'*, ( s'*/+5
)tro$e damage in the
brain can affect the
entire body - resulting in
mild to severe
disabilities. (hese
include paralysis!
problems with thin$ing!
problems with spea$ing!
and emotional problems.
S'*/+ Sy,1*,s
)udden numbness
or wea$ness of the
face! arm! or leg
(especially on one
side of the body)
)udden confusion! trouble
spea$ing or understanding
speech
)udden trouble seeing in
one or both eyes
)udden trouble wal$ing!
di33iness! loss of balance
or coordination
)udden severe headache
with no $nown cause
43( s3*ul6 y*u 6*5
Because stroke injures the
brain, you may not realize
that you are having a stroke.
The people around you might
not know it either. Your family,
friends, or neighbors may
think you are confused. Dont
wait for the symptoms to
improve or worsen.
K.*8 S'*/+ P'+9+.&*.
Conditions that can cause stro$e
are very common among
.frican .mericans. (he best
treatment for stro$e is
prevention. 5ou can reduce your
ris$ of having a stro$e by ta$ing
action to improve your health.
STROKE PREVENTION
Manage your diabetes
#at right
Control your high blood
pressure
#xercise
/on6t smo$e
If you are overweight!
start maintaining a healthy
diet and exercising
regularly.
RHEUMATIC HEART
DISEASE
43( &s R3+u,(&) H+('
D&s+(s+:
7heumatic heart disease is a
condition in which permanent
damage to heart valves is caused
from rheumatic fever. (he heart
valve is damaged by a disease
process that begins with a strep
throat caused by streptococcus .
bacteria! that may eventually cause
rheumatic fever.
43* &s ( '&s/ 2*' '3+u,(&)
2+9+'5
7heumatic fever is uncommon in
the 8)! except in children who
have had strep infections that were
untreated or inade9uately treated.
Children ages : to 2:! particularly
if they experience fre9uent strep
throat infections! are most at ris$
for developing rheumatic fever.
43( ('+ Sy,1*,s *2
R3+u,(&) F+9+':"
fever
red! raised! lattice-
li$e rash! usually on
the chest! bac$ and
abdomen
swollen! tender! red
and extremely
painful joints ;
particularly the
$nees! an$les!
elbows or wrists
nodules! or small
bony protuberances!
over the swollen
joints
sometimes!
wea$ness and
shortness of breath
sometimes!
uncontrolled
movements of arms!
legs or facial
muscles
C(. R3+u,(&) H+('
D&s+(s+ 7+ P'+9+.+6:
(he best defense against
rheumatic heart disease is
to prevent rheumatic fever
from ever occurring by
treating a streptococcus .
bacteria with penicillin or
other antibiotics. (reatment
can usually stop acute
rheumatic fever from
developing.
*eople who have already
had attac$s of rheumatic
fever are more susceptible
to further attac$s and the
ris$ of heart damage. (hey
may be given continuous
monthly or daily antibiotic
treatment! perhaps even for
life. (hey also are given a
different antibiotic when
they undergo dental or
surgical procedures that
may increase the ris$ of
bacterial endocarditis.
43y &s '3+u,(&) 2+9+' (
)*.)+'.5
7heumatic fever! an
inflammatory disease! can
affect many connective
tissues! especially in the
heart! joints! s$in! or brain.
(he infection often causes
heart damage! particularly
scarring of the heart valves!
forcing the heart to wor$
harder to pump blood. (he
damage may resolve on its
own! or it may be
permanent! eventually
causing congestive heart
failure (a condition in
which the heart cannot
pump out all of the blood
that enters it! which leads to an
accumulation of blood in the
vessels leading to the heart and
fluid in the body tissues).
T'+(,+. 2*' '3+u,(&) 3+('
6&s+(s+:
(he best treatment for rheumatic
heart disease is prevention.
.ntibiotics can usually treat strep
throat (a )treptococcus bacterial
infection) and stop acute rheumatic
fever from developing. .ntibiotic
therapy has sharply reduced the
incidence and mortality rate of
rheumatic fever and rheumatic
heart disease.
If inflammation of the heart has
developed! may be placed on bed
rest. Medications are given to
reduce the inflammation! as well as
antibiotics to treat the
)treptococcus infection. <ther
medications may be necessary to
handle congestive heart failure.
If heart valve damage occurs!
surgical repair or replacement of
the valve may be considered.
MYOCARDIAL INFARCTION
R&s/ 2()*'s
7is$ factors for atherosclerosis are
generally ris$ factors for
myocardial infarction"
<lder age
Male gender
Cigarette smo$ing
ypercholesterolemia
(more accurately
hyperlipoproteinemia!
especially high low density
lipoprotein and low high
density lipoprotein)
/iabetes (with or without
insulin resistance)
igh blood pressure
<besity
=>?
(defined by a
body mass index of more
than @A $gBm
,
! or
alternatively by waist
circumference or waist-hip
ratio).
H+(' A()/ Sy,1*,s (.6
4('.&.g S&g.s
C3+s 6&s)*,2*'0 Most
heart attac$s involve
discomfort in the center of
the chest that lasts more
than a few minutes! or that
goes away and comes bac$.
It can feel li$e
uncomfortable pressure!
s9uee3ing! fullness or
pain.
D&s)*,2*' &.
*3+' ('+(s *2 3+
u11+'
7*6y0 )ymptoms
can include pain or
discomfort in one or
both arms! the bac$!
nec$! jaw or
stomach.
S3*'.+ss *2
7'+(30 May occur
with or without
chest discomfort.
O3+' s&g.s: (hese
may include
brea$ing out in a
cold sweat! nausea
or lightheadedness
TREATMENT
L&2+syl+
)3(.g+s
H(9+
'+gul('
,+6&)(l
)3+)/-u1s
S*1
s,*/&.g
E( (
3+(l3y
6&+: (ry to
avoid fatty
foods as
these
contribute to
atherosclero
sis
(narrowed
arteries)!
which is one
of the main
causes of
high blood
pressure.
M(&.(&. (
3+(l3y
8+&g3 "If
you are
overweight!
it is
important
that you try
to lose
weight.
-osing
weight is
about
reducing the
number of
calories you
eat to less
than the
calories you
burn off in
your
everyday
life.
E;+')&s+
'+gul('ly
L&,& y*u' (l)*3*l
&.(/+
H(9+ y*u' 7l**6
1'+ssu'+ )3+)/+6
'+gul('ly: igh
blood pressure is
one of the most
important ris$
factors for heart
H(9+ y*u' 7l**6
)3*l+s+'*l l+9+ls
)3+)/+6 '+gul('ly
R+6u)+ y*u'
s'+ss l+9+ls:
#xercise is often
part of a stress
management
program. )ome
other techni9ues
which may help you
to lower your stress
levels include
relaxation!
meditation and deep
breathing.
C*,1l&)(&*.s
Congestive heart failure
Myocardial rupture
-ife-threatening
arrhythmia
*ericarditis
C('6&*g+.&) s3*)/
Cardiogenic shoc$
DIABETIS MELLITUS
/iabetes mellitus is a chronic
disease caused by the inability
of the pancreas to produce
insulin or to use the insulin
produced in the proper way.
/iabetes is the Cth leading cause
of death among .mericansD over
2: million .mericans suffer
from one form or another of this
disease.
(here are two main types of
diabetes! (ype I and (ype II"
Ty1+ I 6&(7++s or insulin-
dependent diabetes
(formerly called juvenile-
onset diabetes! because it
tends to affect persons
before the age of ,A) affects
about 2A percent of people
with diabetes. 0ith this
type of diabetes! the
pancreas ma$es almost no
insulin.
Ty1+ II 6&(7++s or non-
insulin-dependent diabetes.
(his was previously
called 4adult-onset
diabetes4 because in
the past it was
usually discovered
after age EA.
owever! with
increasing levels of
obesity and
sedentary lifestyle!
this disease is now
being found more
and more in
adolescents - and
sometimes even in
children under 2A -
and the term 4adult
onset4 is no longer
used.
C(us+s (.6 R&s/ F()*'s
*2 D&(7++s
(he cause of (ype I
diabetes is genetically
based! coupled with an
abnormal immune
response.
(he cause of (ype II
diabetes is un$nown! but
that other factors also put
people at ris$ for the
disease include"
sedentary lifestyle
obesity (weighing
,A percent above a
healthy body
weight)
advanced age
unhealthy diet
family history of
diabetes
improper
functioning of the
pancreas
minority race
(higher ris$ in
%lac$! ispanic!
.merican Indian!
westerni3ed .sian
and native awaiian
populations)
medication
(cortisone and some
high blood pressure
drugs)
women having
given birth to a
baby weighing more
than F lbs.
previously
diagnosed
gestational diabetes
previously
diagnosed I'(
Sy,1*,s *2 D&(7++s
(he warning signs and
symptoms for both types
are"
Ty1+ I: Gre9uent urination!
increased thirst! extreme
hunger! unexplained weight loss!
extreme fatigue! blurred vision!
irritability! nausea and vomiting.
Ty1+ II: .ny (ype I symptom!
plus" unexplained weight gain!
pain! cramping! tingling or
numbness in your feet! unusual
drowsiness! fre9uent vaginal or
s$in infections! dry! itchy s$in and
slow healing sores.
N*+: If a person is experiencing
these symptoms! they should see a
doctor immediately.
M(.(g+,+. *2 Ty1+ I D&(7++s
+irtually everyone with
(ype I diabetes (and more
than one in three people
with (ype II) must inject
insulin to ma$e up for their
deficiency.
Pl+(s+ 7+ (8('+ *2 3+ 2*ll*8&.g
1'*7l+,s 3( +;&s 8&3 &.sul&.
&.(/+"
o Hy1*gly)+,&( (low
blood sugar) is
sometimes called an
insulin reaction or
insulin shoc$. It can
occur suddenly in
people using insulin
if too little food is
eaten! if a meal is
delayed or in the
case of extreme
exercise. )ymptoms
include feeling cold!
clammy! nervous!
sha$y! wea$ or
hungry! and some
people become pale!
have headaches or
act strangely.
Hy1+'gly)+,&( (high blood sugar)
occurs when too much food is
eaten or not enough insulin is
o ta$en. (he warning
signs are large
amounts of sugar in
the urine and blood!
fre9uent urination!
great thirst and
nausea.
o K+*()&6*s&s (in its
most severe form -
diabetic coma)
develops when
insulin and blood
sugar are so out of
balance that $etones
accumulate in the
blood. )ymptoms
include high blood
sugar or $etones in
the urine! dry
mouth! great thirst!
loss of appetite!
excessive urination!
dry and flushed
s$in! labored
breathing!
fruity-
smelling
breath and
possible
vomiting!
abdominal
pain and
unconscious
ness.
In
addition to daily
injections of insulin!
regular physical activity
and a controlled diet are
essential. (he .merican
/iabetes .ssociation
(./.) recommends the
following daily dietary
guidelines"
o 8p to CA
percent of
all calories
should be
obtained
from
carbohydrate
s and
unsaturated
fats. (hese
carbohydrate
s should be
mainly
complex
carbohydrate
s and
naturally
occurring
sugars
(simular to
those in mil$
and fruits).
#xamples of
unsaturated
fats are
vegetable
oils and
margarine.
o %etween 2A
and ,A
percent of
calories
should be
obtained
from
protein.
o -ess than 2A
percent of
all calories
should be
obtained
from fat.
)aturated
fats are
found in
animal
products and
in some
vegetable
oils (such as
coconut!
palm! and
palm-$ernel
oils).
o #at @A to @: grams
of fiber.
o #at no more than
@AA mg of
cholesterol.
M(.(g+,+. *2 Ty1+ II D&(7++s
(he ./.
recommends diet
regular physical
activity
oral hypoglycemic
agents
!revention of Diabetes
(here is no foolproof way to
prevent diabetes! but steps can be
ta$en to improve the chances of
avoiding it"
E;+')&s+
L*s+ 8+&g3.
D&+. (he use of a diet low
in calories and in saturated
fat is an ideal strategy for
preventing (ype II diabetes
S*1 s,*/&.g
Us+ (l)*3*l &.
,*6+'(&*.. Moderation
for men means no more
than two drin$s a dayD for
women! one drin$ is the
limit. Choose drin$s that
are low in alcohol and
sugar such as dry wines and
light beers