Liver Diseases

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons.

There are many kinds of liver diseases:

• Diseases caused by viruses, such as hepatitis A, hepatitis B, and hepatitis C.
• Diseases caused by drugs, poisons, or too much alcohol. Examples include steatotic liver disease and cirrhosis.
• Liver cancer.
• Inherited diseases, such as hemochromatosis and Wilson disease.

Symptoms of liver disease can vary, but they often include swelling of the abdomen and legs, bruising easily, changes in the color of your stool and urine, and jaundice, or yellowing of the skin and eyes. Sometimes there are no symptoms. Tests such as imaging tests and liver function tests can check for liver damage and help to diagnose liver diseases.

Living with HIV

What are HIV and AIDS?

HIV stands for human immunodeficiency virus. It harms your immune system by destroying a type of white blood cell that helps your body fight infection.

AIDS is the final stage of infection with HIV. It happens when the body's immune system is badly damaged because of the virus. Not everyone with HIV develops AIDS.

There is no cure for HIV, but there are many medicines to treat both HIV infection and the health problems and infections (called opportunistic infections, or OIs) that come with it. The medicines allow people with HIV to have long, healthy lives.

IIf you have HIV, you can help yourself by:

• Getting medical care as soon as you find out that you have HIV. You should find a health care provider who has experience in treating HIV.
• Taking your medicines every day.
• Letting your provider know if you get any new symptoms or health problems.
• Keeping up with your regular medical and dental care.This includes staying up to date with your recommended health screenings and vaccinations. Your provider can let you know which ones you need.
• Managing stress and getting support, such as from support groups, therapists, and social service organizations
• Trying to live a healthy lifestyle, including:
• Eating healthy foods.This can give your body the energy it needs to fight HIV and other infections. It can help you manage HIV symptoms and medicine side effects. It may also improve absorption of your HIV medicines.
• Getting regular physical activity. This can strengthen your body and immune system. It may also reduce the risk of depression.
• Getting enough sleep. Sleep is important for your physical strength and mental health.
• Not smoking. People with HIV who smoke have a higher risk of developing conditions such as certain cancers and infections. Smoking can also interfere with your medicines. Talk to your provider if you need help quitting smoking.
• Avoiding heavy drinking or taking illegal drugs. They can damage your liver, which means your HIV medicine may not work as well. They can also make it harder for your body to fight infections.
• Protecting yourself from OIs. Talk to your provider about medicines and vaccines that prevent certain OIs. Also, be careful to avoid exposure to contaminated food and water.

It is also important to reduce the risk of spreading HIV to other people. You should tell your sex partners that you have HIV and always use latex condoms. If your or your partner is allergic to latex, you can use polyurethane condoms.

Malnutrition

What is malnutrition?

Malnutrition means that your body isn't getting enough calories or the right balance of nutrients to stay healthy. This can happen if you don't get enough protein, carbohydrates, and fats, eat too much unhealthy food, or don't get the vitamins and minerals your body needs.

Malnutrition can affect people of all ages, but children, older adults, and people with chronic (long-term) health problems have a higher risk.

Most people think of undernutrition with malnutrition. But malnutrition can refer to undernutrition, overnutrition, or an imbalance of nutrients.

Types of malnutrition include:

• Protein-energy undernutrition, also called macronutrient undernutrition, happens when your body doesn't get enough protein or calories from food. Two serious forms of this are kwashiorkor and marasmus.
• An imbalanced nutritional status occurs when you are not getting the right mix of nutrients. You may get enough calories, but not enough vitamins or minerals.
• Vitamin deficiency diseases happen when your body doesn't get enough of certain vitamins. Without the right vitamins, your body cannot stay healthy and may develop specific diseases. For example, scurvy can develop from too little vitamin C, rickets from too little vitamin D, and anemia from too little iron or vitamin B12.
• Failure to thrive occurs when children don't gain weight or grow as expected. This may be due to not getting enough food, trouble absorbing nutrients, or other health problems.
• Overnutrition can occur when your body gets too many calories or nutrients. This may lead to obesity or other health issues.

Malnutrition may occur for many reasons, including:

• An unbalanced diet that lacks variety or specific nutrients.
• Some medical issues, which could include malabsorption syndromes, dementia, eating disorders, depression, alcohol use disorder (AUD), or cancer.
• Problems with swallowing, digestion, or dental issues.
• Certain medicines that affect how food tastes and smells.
• Not being able to get food or cook due to things such as chronic illness, mobility issues, or low income.

Malnutrition can affect anyone, but some people have a higher risk than others. This includes people who:

• Don't have enough knowledge about nutrition
• Don't have access to a variety of food
• Are older adults or children
• Have a low income
• Have a chronic (long-term) illness

The symptoms of malnutrition can vary. You may have no symptoms, but if you do, they may include:

• Fatigue and weakness
• Dizziness
• Losing weight without trying
• Low body weight
• Slow growth or development in children
• Frequent infections or slow healing
• Dry skin or brittle hair and nails
• Swelling in the legs, feet, or belly

To check for malnutrition, your provider may:

• Do a nutritional screening, which may include questions about weight loss, changes in your appetite, and your ability to eat.
• Do a physical exam and order blood tests to check for signs that you don't have enough nutrients.
• Refer you to other providers that specialize in nutrition, such as a dietician.

Treatment for malnutrition may include improving your diet, replacing missing nutrients, and treating the underlying cause.

To help prevent malnutrition, eat a healthy diet with many different foods. Talk with your provider if you are worried about your diet, weight loss, or your child's growth.

Menopause

What is menopause?

Menopause is the time in your life when you stop having your period and can no longer get pregnant. You have reached menopause when you have not had a period for 12 months.

The time leading up to menopause is called the menopausal transition, or perimenopause. This transition usually begins when you are in your 40s, but sometimes it can start earlier. It can last for several years. The most common age for reaching menopause is between 45 and 55 years old.

Early and premature menopause happens when your ovaries stop making hormones and your periods stop at a younger age than usual. When menopause happens before age 40, it's called premature menopause. If menopause happens before age 45, it's called early menopause.

This can happen on its own (with no known cause). It can also happen because of surgery to remove the ovaries. Surgery to remove the uterus alone will cause your periods to stop, but it does not cause menopause unless the ovaries are also removed. Medical treatments such as chemotherapy or hormone therapy used to treat breast cancer may also cause menopause to start earlier than usual.

A condition called primary ovarian insufficiency (POI) happens when your ovaries stop working normally before you are age 40. But this condition is different from early menopause. If you have POI, you may still have periods, even though they might not come regularly. And you might still be able to get pregnant.

Other reasons for early or premature menopause can include:

• A family history of early or premature menopause
• Smoking
• Certain health conditions

During the menopausal transition, your ovaries start to make less of the estrogen and progesterone hormones. The changes in these hormones cause the symptoms of menopause, which can include:

• A change in your periods; they may be:
  • Irregular, with more or less time in between periods.
  • Shorter or longer.
  • Lighter or heavier.
• Hot flashes, a sudden warm feeling in your face, neck, and chest. They may cause you to sweat. If they happen at night and cause sweating, they are called night sweats.
• Trouble sleeping, such as trouble falling asleep or getting back to sleep when you wake up. Over time, a lack of sleep can lead to fatigue and memory problems.
• Vaginal dryness, which may cause pain or discomfort during sexual intercourse.
• Mood changes, which can make you feel moody, anxious, or more irritable.
• Bladder issues, such as urinary incontinence (loss of bladder control) and urinary tract infections (UTIs).

You may also have other physical changes which could put you at risk for certain diseases. For example, the loss of estrogen can:

• Cause you to lose bone density. This can lead to osteoporosis, a condition that causes bones to become weak and break easily.
• Raise your cholesterol levels and increase your risk of heart disease and stroke.

You may not need treatment for the symptoms of menopause. But if you do, there are several different types of treatments:

You may find that you can manage your symptoms with lifestyle changes. Here are some changes that might make you feel better:

• If you have hot flashes, dress in layers that can be removed at the start of a hot flash. You may want to carry a portable fan to use when you get a hot flash.
• Avoid alcohol, spicy foods, and caffeine. They can make your menopause symptoms worse.
• If you smoke, try to quit, not only for hot flashes, but for your overall health.
• Try to maintain a healthy weight. Being overweight or having obesity can make hot flashes worse.
• Have good sleep habits. Keep your bedroom dark, quiet, and cool.
• Get regular exercise. It can help you sleep better, improve your mood, and help lower your risk for many age-related diseases.
• Lower stress, for example by using relaxation techniques such as meditation, deep breathing, and muscle relaxation exercises.

If lifestyle changes are not enough to improve your symptoms, you may want to contact your health care provider. They will talk to you about your symptoms, family and medical history, and preferences. They also can explain the risks and benefits of the treatments.

There are various non-hormone treatments for menopause symptoms, such as:

• Medicines for hot flashes, including certain antidepressants, a medicine just for hot flashes, an antiseizure medicine, and a blood pressure medicine. Some of these medicines may also help with sleep problems.
• Medicines for urinary incontinence.
• Medicines to treat or help prevent osteoporosis.
• Low-dose birth control pills for very heavy bleeding or periods that are close together.
• Water-based lubricants to treat vaginal dryness.
• Medicines for painful intercourse that is caused by vaginal changes from menopause.
• Cognitive behavioral therapy (CBT), a type of talk therapy, for trouble sleeping.

Like all medicines, hormone therapy for menopause has benefits and risks. Talk with your provider about whether it is safe for you. If you decide to take it, your provider may recommend taking the lowest dose that works for the shortest time needed.

There are various products that are marketed for menopause symptoms. They include supplements, herbs, and over-the-counter "natural" hormone creams. There has been research on many of these products, but the results are mixed. Some studies suggest they may help, while others show little or no benefit. Also, there is little information on the long-term safety of these products. Some supplements can have harmful side effects or interact with medicines. Check with your provider before you take any of them.

Mouth Disorders

Your mouth is one of the most important parts of your body. It has many different functions. It allows you to:

• Take in food and drink
• Breathe in air
• Start digestion, with your teeth chewing the food you eat and your salivary glands releasing saliva to help break down the food
• Speak and sing
• Show emotion, by smiling or pouting

Any problem that affects your mouth can make it hard to eat, drink, or even smile. Some common mouth problems include:

• Cold sores - painful sores on the lips and around the mouth, caused by a virus
• Canker sores - painful sores in the mouth, caused by bacteria or viruses
• Thrush - a yeast infection that causes white patches in your mouth
• Leukoplakia - white patches of excess cell growth on the cheeks, gums or tongue, common in smokers
• Dry mouth - a lack of enough saliva, caused by some medicines and certain diseases
• Gum or tooth problems
• Bad breath

Treatment for mouth disorders varies, depending on the problem. If a mouth problem is caused by some other disease, treating that disease can help. It is also important to keep your mouth clean and healthy by brushing, flossing, and not using tobacco.