Talk:Cirrhosis

Review needed
"A study published in 2014 by the scientific journal Nature established the relationship between genetic makeup of the gut microbiota and liver cirrhosis disease. On the basis of these results a combination of 15 microbioal biomarkers can be used to discriminate patients with liver cirrhosis from healthy individuals. "

This is one primary source. Is there a review article that discussing the topic? Doc James (talk · contribs · email) 20:32, 20 June 2016 (UTC)
 * Maybe this one  Doc James  (talk · contribs · email) 20:37, 20 June 2016 (UTC)

NEJM
Global review: 10.1056/NEJMra1504367 JFW &#124; T@lk  09:15, 29 August 2016 (UTC)

Incidence: global, US or what?
We're told "Cirrhosis affected about 2.8 million people and resulted in 1.3 million deaths in 2015". Are these figures for the whole world (which strikes me as very low), or only for the USA (which strikes me as far more plausible)? One of the great failings of English-language Wikipedia articles is that they're all too often based on a US-centred world view, and I fear that may be the case here.89.212.50.177 (talk) 16:41, 19 December 2017 (UTC)

Distinction between cirrhosis and liver cirrhosis?
The article uses the term cirrhosis as if it only applied to the liver. While that is certainly the organ most frequently affected, cirrhosis is a more general term for conditions in which connective tissue proliferates on the expense of parenchyma, which can and does happen in other organs too, e.g. lungs or kidney. I'd thus suggest to move the current liver-centric cirrhosis to liver cirrhosis and to include in the then more general cirrhosis article information about other organs as well. -- Daniel Mietchen (talk) 04:02, 23 December 2018 (UTC)


 * The word "cirrhosis" is used without modifier for cirrhosis of the liver. No other organs are known to develop cirrhosis. No move required IMHO. JFW &#124; T@lk  15:37, 24 December 2018 (UTC)

Coagulation
AGA has published guidance on coagulation management in cirrhosis 10.1053/j.gastro.2019.03.070 JFW &#124; T@lk  19:16, 3 July 2019 (UTC)

Etymology
Generally I see this placed near the end of the article as it pertains to the history of the name of the condition and history generally goes at the end per WP:MEDMOS. Doc James (talk · contribs · email) 22:57, 19 January 2020 (UTC)

Platelet count
Under Diagnosis I read "The best predictors of cirrhosis are [...] platelet count < 160,000/mm3", but the table above refers to "Platelet count x109" and goes down only as low as 40 x 109. Is one of these wrong? Hv (talk) 22:37, 5 October 2020 (UTC)

Queen's University Student Editing Initiative
Hello, we are a group of medical students from Queen’s University. We are working to improve the Cirrhosis article over the next month and will posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you Stepmedz (talk) 20:25, 23 November 2020 (UTC)


 * Hello! This article would definitely benefit from improvements. Given the prevalence of cirrhosis, please focus on using only the very best sources: major reviews in the core medical journals (e.g. Lancet, NEJM, BMJ) and guidelines from the large professional societies. Some content is best sourced from textbooks, such as the signs and symptoms (as these are often lacking from reviews & guidelines, as it is assumed that the reader knows these).
 * I am around intermittently, but please pop a message on my talk page or ping me here if you need assistance. JFW &#124; T@lk  22:27, 23 November 2020 (UTC)

Epidemiology
1.We propose to insert two sentences into the Epidemiology section in order to offer a global perspective of cirrhosis, and move the placement of the sentence on prevalence in males and females to improve the section flow. The updated version of the epidemiology section would be as follows: “Each year, approximately one million deaths are due to complications of cirrhosis, making cirrhosis the 11th most common cause of death globally PMID 30266282. Cirrhosis and chronic liver disease were the tenth leading cause of death for men and the twelfth for women in the United States in 2001, killing about 27,000 people each year.[59] The cause of cirrhosis can vary; alcohol and non-alcoholic fatty liver disease are main causes in western and industrialized countries, whereas viral hepatitis is the predominant cause in low and middle income countries PMID 30266282. Interestingly, cirrhosis is more common in men than in women across the globe. [60] The cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high…” Paixaochampilamaud (talk) 19:51, 3 December 2020 (UTC)

2- In addition, we also propose to add the following paragraph at the end of the Section: Epidemiology - "Globally, age-standardized disability-adjusted life year (DALY) rates have decreased from 1990 to 2017, with the values going from 656.4 years per 100,000 people to 510.7 years per 100,000 people PMID: 31981519. Breaking this down into sex demographics, age-standardized DALY rates in males have decreased from 903.1 years per 100,000 population in 1990, to 719.3 years per 100,000 population in 2017, while in females the DALY rates have decreased from 415.5 years per 100,000 population in 1990, to 307.6 years per 100,000 population in 2017 PMID: 31981519. However, the total number of DALYs have increased globally by 10.9 million from 1990 to 2017, reaching the value of 41.4 million DALYs PMID: 31981519." VittyYo (talk) 19:03, 3 December 2020 (UTC)
 * Thanks for the suggestions here. Please be sure to add your citations properly (as we practiced in class) in the actual article. If you have a chance, please swing back here first and revise so we can see them clearly. Note: Multiple use of the same reference- tech tip. When you add your references while editing, you can see the options "automatic... Manual... Re-use". The first time you add the citation (if it is not already used in an article, click "automatic" and add your PMID, DOI, or website, then click "generate" to fill the template. The second time you want to use the same citation in an article, click "reusue" and search for your citation in the list. This adds in the a,b,c versus duplicating the citation in the list. If possible, practice this in your sandbox before editing live on Monday.JenOttawa (talk) 04:56, 5 December 2020 (UTC)

Complications
1. Under the Section: Complications, we propose to delete the second graph with the heading "Disability-adjusted life year for cirrhosis of the liver per 100,000 inhabitants in 2004". This graph displays information that is fairly outdated (16 years ago). VittyYo (talk) 19:03, 3 December 2020 (UTC)

2. Also within the Complications section, we plan to add a few sentences about the definition and treatment of hepatic encephalopathy because there is currently no information about this topic. The words “Hepatic Encephalopathy will be wiki-linked to the article about this topic. The specific sentences we would like to add are: "Hepatic Encephalopathy is a potential complication of liver cirrhosis that may lead to functional neuronal impairment, ranging from mild confusion to comatose state (PMID: 26164219). Common first line treatment of Hepatic Encephalopathy may include oral lactulose or the antibiotic Rifaximin (PMID: 26164219). Probiotics may also be used as a form of early therapy(PMID: 26164219)." Wafa Khoja (talk) 03:16, 4 December 2020 (UTC)

3- Also within the Complications - Hepatic Encephalopathy section, reference #55 is outdated and cited to explain why nitrogen balance theoretically justified the use of a low protein diet. We found a 2019 practice guideline which better fits WP:MEDRS as a clinical practice guideline and systematic review which directly links study findings to a clinical decision. We propose removing "High-protein food increases the nitrogen balance, and would theoretically increase hepatic encephalopathy; in the past, a low-protein diet was recommended. Recent studies show that this assumption was incorrect, and high-protein foods are even encouraged to maintain adequate nutrition." We propose replacing it with "Past treatment of hepatic encephalopathy included a low-protein diet. It was thought that this diet could help improve the mental status of people with hepatic encephalopathy and portosystemic shunts. However, a low protein diet is no longer recommended because it can cause nutritional deficiencies in people with hepatic encephalopathy." In the same section and based on the same guideline, we wish to add: "Protein uptake is now encouraged to at least match general recommendations for cirrhosis." In the same section and based on the same guideline, we wish to add: “A low protein diet is only recommended for short term use in people with severe hepatic encephalopathy and gastrointestinal bleeding." Spirit&#38;Opportunity (talk) 00:24, 4 December 2020 (UTC)
 * Thanks for sharing this suggestion. Note: Multiple use of the same reference- tech tip. When you add your references while editing, you can see the options "automatic... Manual... Re-use". The first time you add the citation (if it is not already used in an article, click "automatic" and add your PMID, DOI, or website, then click "generate" to fill the template. The second time you want to use the same citation in an article, click "reusue" and search for your citation in the list. This adds in the a,b,c versus duplicating the citation in the list. If possible, practice this in your sandbox before editing live on Monday.JenOttawa (talk) 04:57, 5 December 2020 (UTC)

Lead
We noted that the definition of cirrhosis lacks a clear linkage to fibrosis as being the condition’s causative factor; nor is the medical term fibrosis defined or wiki-linked despite appearing multiple times throughout the article. In order to provide clarity and better understanding of the topic, we propose to remove the article’s second sentence, "This damage is characterized by the replacement of normal liver tissue by scar tissue" and replace it with “Scar tissue formation, known as fibrosis, is formed during the process of liver tissue repair ISBN 978-1-119-23756-3. It is the presence of significant fibrosis from chronic liver damage and subsequent repair that in time can lead to cirrhosis ISBN 978-1-119-23756-3.” Stepmedz (talk) 19:14, 3 December 2020 (UTC)
 * Hi, thanks for all your work here preparing these suggestions. please see above note about adding citations and also how to add the same citation more than once in an article. If this is from a textbook, please include the page numbers that you found this evidence (if available).JenOttawa (talk) 04:58, 5 December 2020 (UTC)

Grading
In the Grading section, we propose to change the following sentence: “More modern scores, used in the allocation of liver transplants but also in other contexts, are the Model for End-Stage Liver Disease (MELD) score and its pediatric counterpart, the Pediatric End-Stage Liver Disease (PELD) score.” into “A more modern score, the Model for End-Stage Liver Disease (MELD) score, uses three laboratory values (total bilirubin, creatinine, and INR) and is primarily used to determine the allocation of liver transplants.” (PMID: 26937922) This sentence previously did not have a reference to support it so we addressed this issue. We added the scoring method for the MELD score to make it consistent with the article’s information about the Child-Pugh score. Additionally, we could not find any WP:MEDRS sources that could support the information on the PELD score so we propose to move the information from the article. Jyyyu (talk) 20:02, 3 December 2020 (UTC)
 * Hi! Thanks for the suggestion to improve grading. See my notes for the other two sections above on citations. Can you add wikilinks to any of these terms?JenOttawa (talk) 05:00, 5 December 2020 (UTC)
 * Thanks for adding the MedLine link. When you are editing the article on Monday, please use the "tool" so that all the fields can be autopopulated. For example, I just clicked "cite" (above), pasted your PMID into the box under the "automatic" tab, and then clicked "generate" to get the following auto-populated citation information pulled from MedLine and formatted in wikicode. I can see that you did it perfectly in your sandbox, so please use that method when editing the article.JenOttawa (talk)

Treatment
In the Treatment section, we propose to remove “and paracetamol (acetaminophen)” from the sentence “Regardless of the underlying cause of cirrhosis, consumption of alcohol and paracetamol (acetaminophen), as well as other potentially damaging substances, are discouraged.” Following this sentence, we propose to add: “Contrary to popular belief, there is no evidence that supports the avoidance or dose reduction of acetaminophen in people with compensated cirrhosis; it is thus considered a safe analgesic for said individuals. " Nkxz4380 (talk) 22:06, 3 December 2020 (UTC)
 * Hi, thanks for working to improve the article. Please see my above comment about inserting your citation using the tool we practiced in class.JenOttawa (talk) 05:00, 5 December 2020 (UTC)

Laennec's cirrhosis
An anonymous account added "See also" to Laennec's cirrhosis. This article has existed since 2007 but duplicates the information in this article. I have therefore redirected it here. Old content is here. JFW &#124; T@lk  21:27, 13 December 2020 (UTC)

WP:MED Collaboration of the Month Feb 2021
Hi all, I don't expect I'll have loads of time to dedicate this month, but I think a nice goal might be to update the sections that are currently bulleted lists: Signs & symptoms, Causes, and Diagnosis#Lab findings. Also a quick scroll through the references shows some older sources. If we could check some more recent sources to make sure that information remains correct, that would be great. Lastly there are two citation needed tags that should both be checked. If folks have other ideas for what needs doing, I'll certainly try to help out. Cheers. Ajpolino (talk) 06:15, 9 February 2021 (UTC)

Infections
Discusses cirrhosis-associated immunodeficiency. 10.1016/j.amjmed.2021.01.015 JFW &#124; T@lk  15:03, 21 December 2021 (UTC)

Wiki Education assignment: WikiMed Feb-Mar 2022 UCSF SOM
Please see above for my proposed contributions. All feedback is appreciated. Some likely resources will include the books below:

Handbook of liver disease. Lawrence S. Friedman, Paul, M.D. Martin (Fourth edition ed.). Philadelphia, PA. 2018. ISBN 978-0-323-47882-3. OCLC 993258172.

Zakim and Boyer's hepatology : a textbook of liver disease. Arun J. Sanyal, Thomas D. Boyer, Norah Terrault, Keith D. Lindor (Seventh edition ed.). Philadelphia, PA. 2018. ISBN 978-0-323-44657-0. OCLC 966671277. — Preceding unsigned comment added by SDpsych (talk • contribs) 09:28, 4 March 2022 (UTC)


 * Peer Review:
 * Signs & Symptoms: Overall I felt the readability was very clear. It was easy to understand and identify the symptoms one can expect to have. I suggest not citing each sentence with the same citation. Your citation is an excellent choice, however maybe just citing the source at the end of the paragraph is sufficient. If there is no change in citation source, it feels overly cited. May I also suggest changing “Further decline” to “worsening cirrhosis” or “Worsening/advancing of disease”. Also “darkly colored urine” may sound better as “dark”.
 * Liver dysfunction: “Likely cause is increase estrogen” may be better worded as “The likely cause is an increase in estrogen.” “Increase of the conversion” may be better as “Increased in the conversion of androgens”. Consider adding a link to “androgen” incase people are unfamiliar with word.”
 * When talking about palmar erythema, thenar and hypothenar could be simplified as “below the thumb and below little finger.”
 * “Hypogonadism signifies a decrease functionality of the gonads and is seen in cirrhosis” consider adding a “d” to “decreased” and maybe remove “and is seen in cirrhosis”
 * Great use of citations and all are appropriate. Easy to follow and understand.
 * Portal Hypertension:
 * “Cruveilhier-Baumgarten bruit is bruit in the epigastric region (on examination by stethoscope). It is due to extra connections forming between the portal system and the paraumbilical veins as a result of portal hypertension.” I think its safe to remove “as a result of portal hypertension” since that’s what this section is discussing.
 * Advanced disease
 * “This is the asynchronous flapping of outstretched, dorsiflexed hands. Fetor hepaticus is a musty breath odor resulting from increased dimethyl sulfide and is a feature of HE.”
 * This section feels a bit difficult to read for the public. The information is great, but I am unsure about the readability.
 * Less common and Imaging: some sections might be difficult to read
 * Overall, very great work. The information is there, and it is well backed up by credible resources which is fantastic. Explaining difficult topics in simple terms is often very challenging and I think you have done a great job so far. I would continue working on making some of the sections still easier to read as mentioned above. Few minor suggestions to revise as discussed above. Keep up the great work. Xkirex (talk) 02:18, 21 March 2022 (UTC)

'''Suggestions for future edits from SDpsych 1) Rewrite intro for improved readability and eliminate number of hyperlinks 2) Elaborate on pathophysiology, prevention, and epidemiology''' — Preceding unsigned comment added by SDpsych (talk • contribs) 23:49, 25 March 2022 (UTC)

Spelling error
Under the heading "liver dysfunction" circulatng is spelled incorrectly. 174.4.72.102 (talk) 15:27, 4 September 2023 (UTC)