Hypertesion

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HYPERTENSION AND CANCEROF THE LIVER

BY

AKULLO BEATRICE

16th Feb 2012

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HYPERTENSION

Brief description;

Hypertension is persistently high resting blood

pressure of more than 140/90 mmHg atleast

two measurements 5mins apart with patient

seated.

Blood pressure is force of the blood pushing

against the walls of the arteries

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Epidemiology

Overall, approximately 20% of the worlds

adults are estimated to have hypertension.

The prevalence is high in patients older than

60yrs in many countries. 50% of the people inthis age group have hypertension.

Worldwide, approximately 1billion people

have hypertension contributing to >7.1milliondeaths per year.

.

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Epidemiology Cont

Age: a progressive rise in Bp with increase in

age. Age related HTN appears to be

predominantly systolic rather than diastolic.

Sex: men more likely to develop HTN than

women

Race: Black individuals have a higher

prevalence and incidence than the whites

persons.

Prevalence has been reported to be increasing

by 50% in blacks.

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Epidemiology cont

In Uganda 46 Africans who were suffering fromhypertension were studied on, there were 34males and 12 females aged between 17-75 years.Only 16 were the age of 40. Hypertension was

secondary to renal disease in 27 cases andprimary or essential hypertension in 14 cases. 11of the subject died from renal failure

Another study was by Wamala et al in Rukungiri

population, 252 out of 852 adults (30.5%) hadblood pressure 140/90 all were on anti-hypertensive.

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How one gets HTN (causes)

Exact cause isnt known in >90% of all cases.

Primary or essential HTN can be associated with;

Hereditary

RaceAge

Obesity

Alcohol sensitivityOral contraceptives

Physical inactivity

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Causes Cont

Certain drugs e.g steroids, decongestants.

Other 10%, HTN (secondary) is attributed to;

Kidney disease

Hormonal imbalance

A tumor of adrenal glands

Anatomical / physiological abnormality. Eclampsia)

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How the disease presents There are no specific symptoms.

General symptoms may include

Headache

Palpitations /dizziness

Shortness of breath. Hypertension may present as a complication

affecting

Brain (stroke)

Eyes (impaired vision)

Heart (heart failure)

Kidney (renal failure.

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Treatment Non drug therapy

Do not add extra salt to cooked food

Increase physical activity/exercise

Reduce body weight

Stop smokingDecrease alcohol intake

Increase potassium intake

Control your stress Drug therapy

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Prevention

Following a healthy eating pattern.

Reduce salt intake

Maintaining a healthy weight

Regular physical exercise

Limiting alcohol intake

Quitting smoking

Early diagnosis and treatment

Health promotion and health education.

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Public health importance

High prevalence and strong association with

cardiovascular disease and premature death.

Preventable through health education..

Causes permanent disability.

Affects socio-economic activities as well as

family productivity.

Regular blood pressure check.

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CANCER OF THE LIVER

Description

Cancer is a general term for malignant andneoplasm, carcinoma or sarcoma.

Malignant: resistant to treatment, occurring insevere form and frequently fatal, tending tobecome worse.

Neoplasm is an abnormal tissue that grows bycellular proliferation more rapidly than normaland continues to grow after the stimuli thatinitiated the growth ceases.

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Description cont

Carcinoma of the liver arises from the liver cellsand is referred to as Primary liver cancer orHepatoma. Cancer originating from other organsto the liver is Secondary liver cancer.

The commonest (90%) of liver tumours aresecondary metastatic tumours from othersources for example stomach, lung, colon, breast,uterus and pancreas.

Primary liver tumours are much less common andmay be Benign (Hepatoma) or Malignant(Hepatocellular carcinoma [HCC])

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Epidemiology

Its 3rd most common cancer in the world. In Sub-Saharan Africa, general occurrence of cancers aresparse.

HCC which is about 90% of the primary liver cancer is

common in China and Sub-Saharan Africa (40% ofcancers) and is rare in the Western countries (2% ofcancers).

It affects people in their 30s and 40s and is associatedwith Hepatitis B.

Men are much more likely than women to have it.

Primary liver cancer incidence trend for Africa areunknown.

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Epidemiology cont

In Uganda, the incidence of cancer is associatewith Poverty and infections. Using the Kampalacancer Registry, data from 1960 to 1980, and1991 to 2005, 771 cases of primary liver cancers

were identified. Although rate were stable among men, incidence

among women increased >50%.

Investigations of Viral hepatitis, aflatoxins,

obesity and human immunodeficiency virus (HIV)may help to explain the increasing incidence ofhepatocellular carcinoma.

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Causes

Oncogene activation

Chemical (tobacco) carcinogenesis

Physical carcinogenesis e.g radiation and skin

irritation.

Viral carcinogenesis: Oncoviruses Hepatitis B, C

Dietary factors related to cancer.

Alcoholism (cirrhosis)

Contraceptive steroids

Personal factors e.g immune function, age and

genetic factors.

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Presentation No specific symptoms

These are discovered at late stage of the

disease.

Fever

Malaise

Anorexia

Unexplained weight loss

Abdominal pain (RUQ)

Jaundice

Hepatomegally and Ascites in complication

Signs of chronic liver disease (finger clubbing, loss of body

hair, parotid enlargement, and small liver at late stage)

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Treatment

Liver transplantation for small (

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Prevention

Avoid excessive intake of animal fat.

Avoid nitrites (prepared lunch meat, sausages,bacon)

Minimize intake of red meats Reduce alcohol consumption (1 or 2 per day)

Eat more cruciferous vegetables (cabbage) andfood high in vitamin A (carrots, leafy green

vegetables) vitamin C (fresh fruits and vegetables. Early diagnosis and treatment

Health promotion and health education

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Why cancer of the liver is of public

health importance

Its fatal, causes majority of deaths with case.

Its preventable since the cause is mainly

secondary.

The treatment is expensive.

Loss of working days.

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Bibliography

Oxford Handbook of tropical medicine, MichaelEddleston Stephan Perini

Uganda Clinical Guideline, 2010, Ministry of Health.

http//medical-dictionary, the freedictionary.com

/hypertension. Oxford hand book of clinical medicine 7th edition

Longmore and Cheung

Medical surgical Nursing 5th edition, Walter KluwerLippincott Williams Wilkins

www.medicienet.com/liver-cancer/article.ntm

www.tropicalmedanhygienejml/.net/article0035-9203

journal lww.com-j hypertension fulltext/2010/0600/hypertension-guideline in Uganda.