Talk:Cirrhosis/Archive 1

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This was the original source citation:


 * Original text from NIH Publication No. 04-1134, December 2003, http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/ 

I removed it after I had began editing. RJFJR 22:52, Dec 25, 2004 (UTC)

The text Original text from  was added back in. I removed and replaced it with an attribution. I don't feel that referring to it as an original source of material is appropriate once we begin editing it. During our editing we will add material from other sources, delete, or reword; all of these could introduce inaccuracies in spite of our best efforts and intentions. It is inappropriate to state the source is material for our own mistakes. RJFJR 03:51, Dec 31, 2004 (UTC)

Images requested
It is requested that this article be expanded with images. The more disgusting and frightening, the better wikipedia will be able to deter people from drinking their livers into oblivion!

I have images of my ERCP, or Endoscopic Retrograde Cholangiopancreatography confirming the diagnosis of Primary Sclerosing Cholangitis, that show what is left of my biliary tree, normally seen on angiography of this type as clearly defined, sharp edged "spagetti noodles" all over the place. In my case, there are nothing left but mere wisps of biliary tracts, upon a very black background. Now if someone can help me with getting these images a)into my computer, and b)onto this site, I would be more than happy to oblige!! AirMed95 05:31, 3 December 2006 (UTC)"Ken" somethings are good though so i will try to keep my head up

Empty talk
>Signs and symptoms of cirrhosis >Liver size. Can be enlarged, normal, or shrunken.

The information content of this sentence in the article is exactly ZERO...
 * —Preceding unsigned comment added by 195.70.32.136 (talk • contribs)


 * No, there is direct information - a small or large liver may be associated with cirrhosis, but not always; similarly enlarged neck lymph nodes may or may not occur with sore throats, but that does not equal an absence of information nor that doctors should not examine for enlarged lymph nodes. If cirrhosis is the scaring up of the liver and eventual loss of liver function, then one might reasonable wonder if the liver enlarges with the initial assault upon it or shrivels up as it scars. The fact that the liver size may or may not be altered in size therefore is of note. Also examining a patient to identify possible enlargement (liver edge extends below the rib cage), or the size of the liver reported on ultrasound scans will not in itself therefore indicate the severity of cirrhosis that has occured. David Ruben Talk 16:33, 6 June 2006 (UTC)

Coffee
Coffee postitively modifies the risk profile. JFW | T@lk  22:26, 12 June 2006 (UTC)

More links: http://www.forbes.com/forbeslife/health/feeds/hscout/2006/06/13/hscout533237.html

Number One on Google
http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/ ranks #1 on Google for "Cirrhosis"NumberOneGoogle 18:29, 25 November 2006 (UTC)


 * Well, there's a link to it here. NIDDK is a good resource. JFW | T@lk  14:13, 1 March 2007 (UTC)

Copyedit
I've done some copyediting. It involved removing all the boldface (WP:MOS), adding the hepato-pulmonary vascular disorders (glaringly absent) and removing the speculative hype about sulfasalazine. I'm much more interested in endothelin antagonism, especially if one considers that sulfasalazine itself can be hepatotoxic.

I suspect we should we mention something about decompensation of cirrhosis - what is done urgently in terms of examinations and treatments. We should talk about fluid management, sodium retention, maintaining nutrition (already briefly covered) and perhaps even acetylcysteine and pentoxifylline.

We need to refer to guidelines more. For example, the BSG have a very good ascites guideline authored mainly by Kevin Moore. JFW | T@lk  14:13, 1 March 2007 (UTC)

Useful review articles for expansion
Link for my own personal use while working on this article:
 * Kevin Moore on Ascites in OTM.
 * Hepatocellular failure

Some papers I don't have fulltext access to:
 * - reviews portal hypertension (2006)
 * - transplantation for end-stage cirrhosis (2000)
 * - safety of endoscopy (2001)
 * - prognosis and survival, systmatic review of 118 studies (2006)
 * - role of infection in the haemodynamics of cirrhosis

I'm planning some work on this article. Stop me if I get too engrossed. JFW | T@lk  16:53, 1 March 2007 (UTC)

Sleep
Cirrhotics sleep poorly, especially when minimally encephalopathic. suggests Hydroxyzine should be tried. JFW | T@lk  14:37, 1 April 2007 (UTC)

Additions
made a very large addition (22 KB) to the article, replacing the preexisting "general care" paragraph. Unfortunately, there are several problems with the material added:
 * It is highly technical (basic pathophysiological research being cited instead of clinical papers).
 * It gives the suggestion that it was copied verbatim from a recent review paper (but I cannot confirm a copyvio from simple Google checks).
 * The footnotes do not follow the cite.php-based system previously in place.

I have asked the contributor to comment here. Obviously, I would not want to turn off an editor with an obvious interest in chronic liver disease. JFW | T@lk  14:12, 14 May 2007 (UTC)

Bye bye, Dr Quick
PT/INR is quite rubbish to stratify risk in cirrhosis, JFW |  T@lk  22:54, 23 June 2007 (UTC)

Circular Reference
The page has a link to "Cardiac cirrhosis" (in the Causes section). This link Takes the user to the page that the user is already on. This may need fixing/changing. Cs1kh 14:33, 31 July 2007 (UTC)


 * Perhaps you want to turn the redirect into a stub? JFW | T@lk  21:45, 24 September 2007 (UTC)

Thrombosis
I have long suspected that cirrhotics are actually a tad prothrombotic due to various mechanisms, and many cirrhotics I have looked after have had a history of VTE. addresses this issue, as well as pointing out how poorly we can measure coagulation in liver disease. I reckon it's all about decreased fibrinolytic activity. JFW | T@lk  21:45, 24 September 2007 (UTC)

Platelets
- a myth shattered. Platelet count is moderately predictive of the portal venous gradient, but not of oesophageal varicosis. JFW | T@lk  07:32, 30 December 2007 (UTC)


 * - ALT, INR and albumin can be used to predict clinically significant portal hypertension (CSPH). A low CSPH score would mean that screening for varices is a waste of time - in this series this applied to 40% of the cohort. JFW | T@lk  09:11, 11 May 2008 (UTC)

Patek
- was the Patek regimen as popular in the past as some old publications seem to indicate? JFW | T@lk  15:15, 15 May 2008 (UTC)

- probably the most concise summary of cirrhosis I've ever seen. A great example of how this article could work. JFW | T@lk  09:28, 30 May 2008 (UTC)

Further Additions, in Regards to Current Research and Treatment
I have noticed that on some medical pages on Wikipedia that they will add further additions in detailing research into treatments. I have recently come across some articles in the fight against liver cirrhosis and news of potential methods for a cure. Would it be allright to add them? EmilyGreene1984 10:26, 16 September 2008 (UTC) Here is also a link to a company called "Arbios", who are developing several liver-assistance devices that are supposed to help in the treatment of acute-on chronic or acute liver disease. While they don't have any devices that can help in the treatment of cirrhosis itself, their research is of particular interest - especially in regards to severe liver disease. http://www.arbios.com/
 * Credible scientific literature is always welcome. So long as the articles are reliable references, discussions about future therapies or therapies in development is very relevant to medical articles. If you are unsure about the quality of the literature you are citing, post it here in discussion (along with what content you'd like to include in the article that the referenced source supports) first for comment before adding to the article. Chaldor (talk) 06:48, 17 September 2008 (UTC)
 * I have found a few online articles detailing further research into treatments and potential cures for cirrhosis, but I am not sure if these should be posted as official references. Here are the following references to the medical research. http://www.timesonline.co.uk/tol/life_and_style/health/article3099320.ece (Times Online.co.uk), http://www.medicalnewstoday.com/articles/85274.php (Medical News Today), and http://www.sciencedaily.com/releases/2007/12/071226225538.htm (Science Daily).

There were some other references, but I can't recall the links at the moment. But I will post the links as soon as I find them again. EmilyGreene1984 (talk) 08:01, 9 November 1984 (UTC)

RECOVERY FROM CIRRHOSIS.
There can be recovery from cirrhosis. I have HEP-C cirrhosis of the liver. My specialist tells me some recovery is possible. I suppose some recovery is better news than no hope of recovery. See article: "Is cirrhosis of the liver reversible?" http://www.ncbi.nlm.nih.gov/pubmed/17476087

The reference is from National Center for Biotechnology Information (NCBI), which is a part of the National Institutes of Health (NIH).

Info on NCBI:

"The late Senator Claude Pepper recognized the importance of computerized information processing methods for the conduct of biomedical research and sponsored legislation that established the National Center for Biotechnology Information (NCBI) on November 4, 1988, as a division of the National Library of Medicine (NLM) at the National Institutes of Health (NIH). NLM was chosen for its experience in creating and maintaining biomedical databases, and because as part of NIH, it could establish an intramural research program in computational molecular biology. The collective research components of NIH make up the largest biomedical research facility in the world." http://www.ncbi.nlm.nih.gov/home/about/mission.shtml

69.66.126.103 (talk) 19:08, 28 July 2015 (UTC)

Essentials
Cirrhosis essentials was added to the article. At the moment, there is absolutely no precedent for using template space to write article summaries and displaying these in that fashion. WikiProject Haystack seems to be behind this, but the person who added the box is its only member and the WikiProject is still in its proposal phase. I think this needs to mature before being rolled out. JFW | T@lk  20:50, 1 November 2008 (UTC)


 * All right, let's wait for a while. I can use the old version of the article to show the example. Mikael Häggström (talk) 05:40, 2 November 2008 (UTC)

My view is that we should rather improve the intro and use the intro as the "essentials" content. Having article summaries away from the article namespace somehow sounds like a potential source of trouble, although I stand entirely behind the motive of your WikiProject. JFW | T@lk  11:04, 2 November 2008 (UTC)


 * Improving the intro is a good idea, whether or not the haystack project will be fully carried out, since it may provide a good source for what would be included in the separate summary box. The idea is that this separate summary box, being the vitals of a vital article, also could be separately searched for in the search engine by people with limited time or mobile users. See project main page for more info. We'll see in time if the project receives enough support. Mikael Häggström (talk) 16:28, 2 November 2008 (UTC)

Sulfasalazine
Some evidence indicates that treatment of cirrhosis of the liver may include the drug "sulphasalazine" (which might actually reverse liver cirrhosis; Cite: http://www.jointogether.org/news/headlines/inthenews/2006/drug-can-reverse-cirrhosis.html) —Preceding unsigned comment added by 67.233.181.171 (talk) 02:53, 29 November 2008 (UTC)  sorry this was paragraph was edited by me, I just signed in. email me at dsyn22 (at) gmail.com if you have any questions about my suggestion! Thanks.


 * Well, animal studies are usually hypothesis-generating only. Wikipedia only really discusses animal studies in the most exceptional circumstances. I can't find the original study on Pubmed at the moment. JFW | T@lk  21:49, 29 November 2008 (UTC)

Indian childhood cirrhosis
Indian childhood cirrhosis now redirects here. It should be mentioned in the article, and if there is a lot of material on it, the redirect can be turned into its own article. This condition is mentioned in a lot of Wikipedia articles. -- Beland (talk) 08:12, 2 February 2009 (UTC)

Biliary atresia
In etiologies of cirrhosis, a major omission has been made. Please add the following:

Biliary atresia. This is the most common form of cirrhosis in childhood, accounting for more than 50% of liver transplantations. Biliary atresia is characterized by a partial to complete loss of the bile ducts draining the liver, leading to progressive biliary cirrhosis. The majority of bile ductular damage in biliary atresia occurs prior to birth. Biliary atresia is fatal in the absence of diverting surgery (hepatoportoenterostomy, or Kasai procedure) or liver transplantation.


 * You can do it yourself when you're autoconfirmed. JFW | T@lk  07:29, 23 February 2009 (UTC)

Clotting
Another study that shows that cirrhosis is indeed a procoagulant state. JFW | T@lk  22:25, 22 December 2009 (UTC)

Image
Can someone edit the image caption to include a description of what that actually is? At first it looked like someone's lower torso, but I don't think so as I see no navel. Darkgroup (talk) 03:59, 23 November 2011 (UTC)


 * It is an abdomen with an effaced umbilicus. Rephrased. JFW &#124; T@lk  07:13, 23 November 2011 (UTC)

I'm not sure this image shows a particularly good example of caput medusae. Could someone who knows a bit more about hepatology/cirrhosis either confirm or edit the caption? I haven't examined enough abdomens to know. Triswithers (talk) 11:45, 11 July 2012 (UTC)
 * You can see a few dilated blood vessels radiating from the central area of the abdomen if you look closely. Need an expert to state whether this is a typical presentation, in which case I think we should keep the image rather than substitute it for a more severe but unrealistically obvious image. Lesion  ( talk ) 11:39, 12 April 2013 (UTC)

not written like an encyclopedia article
This article is not written like an encyclopedia article. After the lead, it launches into two extremely lengthy bullet lists.--75.83.69.196 (talk) 06:00, 27 November 2011 (UTC)


 * There is a very large amount of information to be covered, and some of it is sequential (e.g. lists of causes). I agree that bullet points are stylistically inappropriate. Feel free to make a start at changing it! JFW &#124; T@lk  08:15, 27 November 2011 (UTC)

Hypertrophic osteopathy
I think the wikilink in this article Hypertrophic osteopathy needs to be changed, since that article is about a disease in animals, or so the hatnote says. Lesion ( talk ) 11:36, 12 April 2013 (UTC)

Edit Request
Under 'Non-alcoholic steatohepatitis' (causes) please can someone help to insert the following as my citation skills are not great. I would like someone to add the following sentences:

There may be a relationship between the risk of alcoholic cirrhosis and some unknown dietary contributing factor related to pork, or fat consumption. This is supported by research that has shown a positive association between pork consumption and cirrhosis mortality, the product of alcohol and pork consumption and the product of alcohol and fat consumption. Source: Relationship between dietary beef, fat, and pork and alcoholic cirrhosis. Author: Bridges FS. International Journal of Environmental Research and Public Health. 2009 Sep;6(9):2417-25. doi: 10.3390/ijerph6092417. Epub 2009 Sep 10. Department of Health, Leisure and Exercise Science, University of West Florida, Pensacola, FL 32514-5750, USA. fbridges@uwf.edu http://www.ncbi.nlm.nih.gov/pubmed/19826553

A secondary source of the same study above might include: 'Is Pork Still Dangerous?' - Psychology Today. February 8, 2012. Authors: Paul Jaminet, Ph.D., and Shou-Ching Jaminet, Ph.D. http://www.psychologytoday.com/blog/perfect-health-diet/201202/is-pork-still-dangerous

Help with including this in the article on my behalf will be greatly appreciated.--197.79.8.214 (talk) 19:40, 7 June 2013 (UTC)


 * The current thinking is that NAFLD is not due to one particular form of energy overload but just too much energy in those who are genetically susceptible. There are better sources. JFW &#124; T@lk  22:01, 10 June 2013 (UTC)

Signs and Symptoms
This section was previously just a long list. I have now grouped them by the major causes of the signs and symptoms and added references to the individual signs and symptoms. This will make it much easier to navigate for users. — Preceding unsigned comment added by Eaamed (talk • contribs) 03:51, 10 December 2013 (UTC)


 * Good stuff, that section needed a bit of love. I have tweaked the headers a bit. JFW &#124; T@lk  17:25, 10 December 2013 (UTC)

Make technical articles understandable
I can see this as a problem in this article. It is however difficult to make it simple without diluting the value of the information presented. Any help in doing this would be appreciated. Eaamed (talk) 18:15, 12 December 2013 (UTC)

Intro. correction
The statement:

'Cirrhosis is irreversible, and treatment usually focuses on preventing progression and complications.'

might have been true when this article was first created but not anymore. Example:

http://www.medscape.com/viewarticle/772507

Is it OK to change the above sentence to:

′Cirrhosis can be reversible but was once considered irreversible.'

then site the above article? Mark B (talk) 21:44, 21 December 2013 (UTC)


 * In pathophysiological perspective, the process that underlies cirrhosis may be reversible. In clinical terms, however, this is very much not the case yet. I would be very hestitant to state with such certainty that we can return people's livers to their normal state! JFW &#124; T@lk  22:27, 21 December 2013 (UTC)

Portal hypertension
An anonymous editor added: "Portal hypertension can be divided into 3 types : pre-hepatic, hepatic and post-hepatic."

This is not a classification that is widely used. To my knowledge, only hepatic and post-hepatic portal hypertension are recognised. The former is the most common (mediated by chronic liver disease, sometimes indirectly in the context of cardiac failure), and the latter may occur as a result of - for instance - schistosomiasis. At any rate, the distinction doesn't need to be made in this article. JFW &#124; T@lk  23:20, 21 December 2013 (UTC)

Lancet Seminar 2014
New one: Emmanuel A Tsochatzis EA, Bosch J, et al.  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960121-5/abstract Liver cirrhosis (2014) The Lancet. Jan 28; doi:10.1016/S0140-6736(14)60121-5

This article has a discussion of prognosis, dividing cirrhosis into 5 prognostic stages, with their likelihood of mortality:

Stage 1 (compensated with no esophageal varices) mortality 1%/year

Stage 2 (compensated with varices) mortality 3-4%/year

Stage 3 (decompensated with ascites) mortality 20%/year

Stage 4 (decompensated with gastrointestinal bleeding) mortality 57%/year

Stage 5 (infections and renal failure) mortality 67%/year.

-- Nbauman (talk) 23:41, 2 February 2014 (UTC)


 * WP:BOLD. Sounds good. JFW &#124; T@lk  20:45, 3 February 2014 (UTC)

HCC screening
10.7326/M14-0558 - the evidence for screening is rather weak. JFW &#124; T@lk  10:03, 17 June 2014 (UTC)

Split off decompensation?
Acute on chronic liver failure (ACLF) is a distinct concept that we should treat in a separate article.

Lancet: 10.1016/S0140-6736(15)00309-8 (authorship by two major London units). JFW &#124; T@lk  14:11, 19 October 2015 (UTC)