![]() | Hepatic encephalopathy has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do so. If it no longer meets these criteria, you can reassess it. | ||||||||||||
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![]() | Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Hepatic encephalopathy.
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What other causes of hepatic encephalopathy are there that are not due to liver disease? JFW | T@lk 17:44, 9 November 2005 (UTC)
Although this article is tight from a clinic standpoint and should remain as is, it lacks the human aspect of somebody who has suffered the disease and has lived to tell about it.
As far as treatment, lactulose will work to a certain degree, but not how most doctors recomend its dosage. I have found that lactulose works well when confusion and or brain swelling(headache) sets in on an as needed basis. Otherwise, any caloric and vitamin intake that is not readily processed by the weakened liver, will be flushed with the unabsorbed ammonium (NH4+) and will result in unhealthy weight loss and a weakened patient.
When the article speaks of decreasing protien loss to help lessen the effect of ammonia (NH3) buildup, this is quite true, but it fails to mention that the kind of protien that is most dangerous is animal protiens with beef being the worst offender. From what I understand, even with slight brain damge from seven years of lethal amounts of ammonia (186+) in my bloodstream before my transplant, the animal protiens cannot be broken down by a weakened liver and those protiens are made into the simplest byproduct, ammonia. Unfortunately, the human body cannot do without protien intake at all, so it is usually recomended that the patient find a more readily soluable protiens such as those found in non-animal sources and eggs. Cunsult a nutritionist and your doctor for a solution for a suitable diet plan.
As mentioned in the above article, there is a flapping tremor that is associated with this disease, but it fails to mention how closely this symptom has to be watched. Shaking hands are normal to a degree, but if the arm is fully extended with the fingertips pointing at the ceiling and the hand is flapping like somebody waving, it is a sign that the patient has very little time left as this is what is known in doctor's circles as "the wave good-bye."
Just for the record, I'd like to expand on the different "grades" of this disease, these "grades" can be mixed and matched and a symptom listed in "grade 3" can be present in "grade 2" depending on the person. As far as "amnesia" goes, there will be confusion in the patient as to what place and time they are in, but a patient lives longer with the disease (and that is quite possible), there might be a form of regression as in a 37 year old patient might wake up with the memories from 16+ years temporarily unacessable for a short period of time. This is not a good time to force feed them their true age, because the patient may become scared and violent.
Speaking of these violent "fits of rage," this is due to confusion and is usually not all that dangerous to anyone but the patient as long as the patient doesn't have access to weapons. When I say weapons, I include the patient driving vehicles. A patient with this disease does not respond well to stress since it will increase the confusion and they should NOT be allowed to drive or have access other weapons including kitchen knives. Truthfully, they shouldn't be allowed to operate any cooking appliance without supervision. I say this because a patient with this disease can be easily fixated on a fire and forget how dangerous it is.
As a final note, I'd like o make crystal clear that there are several ways to get liver cirrhosis besides alcoholism and hepatitis and in no way whatsoever should a person assume that a patient with cirrhosis brought it upon themselves. I take offense to these clinical articles always referring to alcoholism based cirrhosis an example of its symptomology. As a matter of fact, there are increasing cases of "cryptogenic" liver cirrhosis. That means that the doctors have no clue as to how or why it happened. Believe me, if it was alcoholism, it would be easily detectable. Please keep that in mind before you pass judgement on somebody fighting for their life.
2005 (UTC)
Another subject for consideration is the "after affects" of the impact. I am a liver transplant receiptant (for "crypotogenic reasons") who had a sustained two week period of major encephalopathy which was overcome by the use of lactalose (4 times a day). I suspect, even though I don't have the confusion issues to deal with, that I do have some dimunition of mental ability -- and maybe it is strictly because of age in combination with the remants of the disease. The changes are not dramatic to the rest of the world -- and maybe not evident to them -- but I can detect a change. Small loses of cognitive ability. I was involved in a research project during my disease to check the relationship of a possible link to "hemocromotosis". It would be interesting to continue the testing now, to see the relationship of my answers now -- to then. 75.34.95.100 17:38, 24 January 2007 (UTC)
Speaking as another former sufferer who lived with the condition for a year in all degrees of severity from mild befuddlement to coma, I just wanted to note that mental subtraction becomes difficult before addition, not afterwards. It seems obvious, but the article incorrectly states the opposite.
I, too, was on lactulose 4x/day, but it did absolutely nothing for me as far as I could tell; all relief came from antibiotics. Cirrhosis was from far too much acetaminophen during a long bout of the flu coupled with previously undiagnosed hemochromatosis. —Preceding unsigned comment added by 71.219.36.42 ( talk) 10:59, 2 December 2009 (UTC)
PMID 429564 shows how ammonia is "trapped" in the brain. JFW | T@lk 23:01, 31 March 2007 (UTC)
doi: 10.1111/j.1365-2036.2007.03394.x - the new CHESS score (0-9). JFW | T@lk 21:04, 6 June 2007 (UTC)
doi: 10.1111/j.1365-2036.2007.03464.x APT article on cost-effectiveness. Discourages routine use of rifamixin & suggests reserving it for those who fail on lactulose. JFW | T@lk 22:27, 9 August 2007 (UTC)
Herbs of chicory root and milk thistle.
Some very good information on this.
Having known someone who suffered from this may I suggest , Herbs of chicory root and milk thistle, that are well known to treat the liver.... ( citation needed)
--Caesar J. B. Squitti : Son of Maryann Rosso and Arthur Natale Squitti 20:53, 5 March 2008 (UTC)
— Preceding unsigned comment added by Caesarjbsquitti ( talk • contribs) 20:53, 5 March 2008 (UTC)
doi: 10.1093/qjmed/hcp152 is a nice general review from Ireland that I intend to use to replace numerous primary sources. JFW | T@lk 10:47, 18 February 2010 (UTC)
{{
cite journal}}
: Unknown parameter |month=
ignored (
help){{
cite journal}}
: Explicit use of et al. in: |author=
(
help); Unknown parameter |month=
ignored (
help)CS1 maint: multiple names: authors list (
link) (mainly about MHE, but worth mentioning)In the "treatment" section we need to mention a few Cochrane reviews. Most of them are negative. They're all in this list. It should be clear that Cash shrugs at the Cochrane lactulose review, and states that from experience the stuff works. I don't think we can avoid citing that, but it would be nice if there were other sources also nixing the review. JFW | T@lk 23:03, 21 February 2010 (UTC)
Having just completed the "diagnosis" section, I thought I should do a little list of things to do:
Any help appreciated, as always. JFW | T@lk 01:54, 22 February 2010 (UTC)
In all the reading I have not really come across a good historical overview of HE. I've had the temerity to email Prof Harold Conn, whose West Haven work is still relied upon, and am awaiting a reply. Otherwise there's some bits from Weissenborn as described.
I might list some interesting historical sources here, not suggesting that all are included.
JFW | T@lk 00:26, 23 February 2010 (UTC)
Bajaj in his 2010 APT review lists the Critical Flicker Frequency test and the Inhibitory Control Test. I decided not to mention them because the Randolph paper does not recommend them, and because Bajaj concedes that they still need validating. JFW | T@lk 09:58, 2 March 2010 (UTC)
Only Colin ( talk · contribs) was good enough to respond to the peer review, but I have incorporated most of his recommendations and am therefore submitting for GA. JFW | T@lk 21:50, 14 March 2010 (UTC)
Reviewer: Okay, I will start reviewing here and do some copyediting as I go. Please revert any changes I inadvertently make to meaning. Hopefully I will try to give it a bit of a shove to FAC. I will jot queries below. Cheers, Casliber ( talk · contribs) 09:24, 10 April 2010 (UTC)
Otherwise lookin' good. Casliber ( talk · contribs) 00:34, 11 April 2010 (UTC)
Will work the terminology into the article body. The Harrison's source doesn't say where the other substances come from. JFW | T@lk 23:49, 12 April 2010 (UTC)
May as well haul out the green '+' icons then...
1. Well written?:
2. Factually accurate and verifiable?:
3. Broad in coverage?:
4. Reflects a neutral point of view?:
5. Reasonably stable?
6. Illustrated by images, when possible and appropriate?:
Overall:
In addition to BNZs, oral anticoagulants such as coumarins (warfarin) may also cause hepatic encephalopathy. —Preceding unsigned comment added by 92.28.33.151 ( talk) 16:29, 9 May 2010 (UTC)
doi:10.1111/j.1365-2036.2011.04590.x - consensus statement on the design of clinical trials. This is hopeful. Perhaps we'll get some more hard data on the various treatments soon. JFW | T@lk 22:06, 1 October 2011 (UTC)
Small trial, not for inclusion but interesting in case secondary sources appear: doi:10.1136/gutjnl-2012-303262 (PHE score comes out best). JFW | T@lk 20:39, 14 September 2013 (UTC)
Wijdicks doi:10.1056/NEJMra1600561 JFW | T@lk 08:10, 27 October 2016 (UTC)
![]() | This edit request by an editor with a conflict of interest was declined. |
I added the following links in External Links section
These links were removed. After a discussion with user:Doc James I became aware of Wiki’s conflict of interest policy. I hope to navigate that policy carefully.
The first link is a video that I created, and is therefore a conflict of interest for me to post. I would ask that a third party look into the video and decide it’s worthiness.
I receive advertisement fees for videos. This is one of my top videos—and is not likely to see an significant increase in traffic from posting here. I am not allowed to disclose earnings from YouTube, but suffice to say, even if views on this video were to double annually for the next 10 years, I’d still have made less in those years than I would in a week at a part time job. Tmbirkhead ( talk) 05:27, 11 December 2017 (UTC)
I can see no rationality in the responses, so far. I will wait to see what replies come in from the rebuttals that I have posted, but without any request for my response, I am done trying. This was a fools errand. I tried to make Wikipedia a better place, but have, thus far, been prevented from doing that by a group that won’t even take the time to examine the content of my contribution. The contribution I didn’t have to make available to the public, a contribution that doesn’t bring me (nor ever will) great fame or wealth. And I have pointed out to at least some of you the obvious double standard where some YouTube videos are linked with very little (weak) relationship to a primary article, but they are allowed to stay. I honestly have nothing to gain from this other than the satisfaction of knowing that I made the worlds largest encyclopedia a little bit better. And when the historians judge; they will point to the few users above as individuals that (in this case) prevented that improvement. goodnight. Tmbirkhead ( talk) 10:44, 13 December 2017 (UTC)
![]() | Hepatic encephalopathy has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do so. If it no longer meets these criteria, you can reassess it. | ||||||||||||
| |||||||||||||
Current status: Good article |
![]() | This article is rated GA-class on Wikipedia's
content assessment scale. It is of interest to the following WikiProjects: | ||||||||||||||||||||||||||
|
![]() | Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Hepatic encephalopathy.
|
What other causes of hepatic encephalopathy are there that are not due to liver disease? JFW | T@lk 17:44, 9 November 2005 (UTC)
Although this article is tight from a clinic standpoint and should remain as is, it lacks the human aspect of somebody who has suffered the disease and has lived to tell about it.
As far as treatment, lactulose will work to a certain degree, but not how most doctors recomend its dosage. I have found that lactulose works well when confusion and or brain swelling(headache) sets in on an as needed basis. Otherwise, any caloric and vitamin intake that is not readily processed by the weakened liver, will be flushed with the unabsorbed ammonium (NH4+) and will result in unhealthy weight loss and a weakened patient.
When the article speaks of decreasing protien loss to help lessen the effect of ammonia (NH3) buildup, this is quite true, but it fails to mention that the kind of protien that is most dangerous is animal protiens with beef being the worst offender. From what I understand, even with slight brain damge from seven years of lethal amounts of ammonia (186+) in my bloodstream before my transplant, the animal protiens cannot be broken down by a weakened liver and those protiens are made into the simplest byproduct, ammonia. Unfortunately, the human body cannot do without protien intake at all, so it is usually recomended that the patient find a more readily soluable protiens such as those found in non-animal sources and eggs. Cunsult a nutritionist and your doctor for a solution for a suitable diet plan.
As mentioned in the above article, there is a flapping tremor that is associated with this disease, but it fails to mention how closely this symptom has to be watched. Shaking hands are normal to a degree, but if the arm is fully extended with the fingertips pointing at the ceiling and the hand is flapping like somebody waving, it is a sign that the patient has very little time left as this is what is known in doctor's circles as "the wave good-bye."
Just for the record, I'd like to expand on the different "grades" of this disease, these "grades" can be mixed and matched and a symptom listed in "grade 3" can be present in "grade 2" depending on the person. As far as "amnesia" goes, there will be confusion in the patient as to what place and time they are in, but a patient lives longer with the disease (and that is quite possible), there might be a form of regression as in a 37 year old patient might wake up with the memories from 16+ years temporarily unacessable for a short period of time. This is not a good time to force feed them their true age, because the patient may become scared and violent.
Speaking of these violent "fits of rage," this is due to confusion and is usually not all that dangerous to anyone but the patient as long as the patient doesn't have access to weapons. When I say weapons, I include the patient driving vehicles. A patient with this disease does not respond well to stress since it will increase the confusion and they should NOT be allowed to drive or have access other weapons including kitchen knives. Truthfully, they shouldn't be allowed to operate any cooking appliance without supervision. I say this because a patient with this disease can be easily fixated on a fire and forget how dangerous it is.
As a final note, I'd like o make crystal clear that there are several ways to get liver cirrhosis besides alcoholism and hepatitis and in no way whatsoever should a person assume that a patient with cirrhosis brought it upon themselves. I take offense to these clinical articles always referring to alcoholism based cirrhosis an example of its symptomology. As a matter of fact, there are increasing cases of "cryptogenic" liver cirrhosis. That means that the doctors have no clue as to how or why it happened. Believe me, if it was alcoholism, it would be easily detectable. Please keep that in mind before you pass judgement on somebody fighting for their life.
2005 (UTC)
Another subject for consideration is the "after affects" of the impact. I am a liver transplant receiptant (for "crypotogenic reasons") who had a sustained two week period of major encephalopathy which was overcome by the use of lactalose (4 times a day). I suspect, even though I don't have the confusion issues to deal with, that I do have some dimunition of mental ability -- and maybe it is strictly because of age in combination with the remants of the disease. The changes are not dramatic to the rest of the world -- and maybe not evident to them -- but I can detect a change. Small loses of cognitive ability. I was involved in a research project during my disease to check the relationship of a possible link to "hemocromotosis". It would be interesting to continue the testing now, to see the relationship of my answers now -- to then. 75.34.95.100 17:38, 24 January 2007 (UTC)
Speaking as another former sufferer who lived with the condition for a year in all degrees of severity from mild befuddlement to coma, I just wanted to note that mental subtraction becomes difficult before addition, not afterwards. It seems obvious, but the article incorrectly states the opposite.
I, too, was on lactulose 4x/day, but it did absolutely nothing for me as far as I could tell; all relief came from antibiotics. Cirrhosis was from far too much acetaminophen during a long bout of the flu coupled with previously undiagnosed hemochromatosis. —Preceding unsigned comment added by 71.219.36.42 ( talk) 10:59, 2 December 2009 (UTC)
PMID 429564 shows how ammonia is "trapped" in the brain. JFW | T@lk 23:01, 31 March 2007 (UTC)
doi: 10.1111/j.1365-2036.2007.03394.x - the new CHESS score (0-9). JFW | T@lk 21:04, 6 June 2007 (UTC)
doi: 10.1111/j.1365-2036.2007.03464.x APT article on cost-effectiveness. Discourages routine use of rifamixin & suggests reserving it for those who fail on lactulose. JFW | T@lk 22:27, 9 August 2007 (UTC)
Herbs of chicory root and milk thistle.
Some very good information on this.
Having known someone who suffered from this may I suggest , Herbs of chicory root and milk thistle, that are well known to treat the liver.... ( citation needed)
--Caesar J. B. Squitti : Son of Maryann Rosso and Arthur Natale Squitti 20:53, 5 March 2008 (UTC)
— Preceding unsigned comment added by Caesarjbsquitti ( talk • contribs) 20:53, 5 March 2008 (UTC)
doi: 10.1093/qjmed/hcp152 is a nice general review from Ireland that I intend to use to replace numerous primary sources. JFW | T@lk 10:47, 18 February 2010 (UTC)
{{
cite journal}}
: Unknown parameter |month=
ignored (
help){{
cite journal}}
: Explicit use of et al. in: |author=
(
help); Unknown parameter |month=
ignored (
help)CS1 maint: multiple names: authors list (
link) (mainly about MHE, but worth mentioning)In the "treatment" section we need to mention a few Cochrane reviews. Most of them are negative. They're all in this list. It should be clear that Cash shrugs at the Cochrane lactulose review, and states that from experience the stuff works. I don't think we can avoid citing that, but it would be nice if there were other sources also nixing the review. JFW | T@lk 23:03, 21 February 2010 (UTC)
Having just completed the "diagnosis" section, I thought I should do a little list of things to do:
Any help appreciated, as always. JFW | T@lk 01:54, 22 February 2010 (UTC)
In all the reading I have not really come across a good historical overview of HE. I've had the temerity to email Prof Harold Conn, whose West Haven work is still relied upon, and am awaiting a reply. Otherwise there's some bits from Weissenborn as described.
I might list some interesting historical sources here, not suggesting that all are included.
JFW | T@lk 00:26, 23 February 2010 (UTC)
Bajaj in his 2010 APT review lists the Critical Flicker Frequency test and the Inhibitory Control Test. I decided not to mention them because the Randolph paper does not recommend them, and because Bajaj concedes that they still need validating. JFW | T@lk 09:58, 2 March 2010 (UTC)
Only Colin ( talk · contribs) was good enough to respond to the peer review, but I have incorporated most of his recommendations and am therefore submitting for GA. JFW | T@lk 21:50, 14 March 2010 (UTC)
Reviewer: Okay, I will start reviewing here and do some copyediting as I go. Please revert any changes I inadvertently make to meaning. Hopefully I will try to give it a bit of a shove to FAC. I will jot queries below. Cheers, Casliber ( talk · contribs) 09:24, 10 April 2010 (UTC)
Otherwise lookin' good. Casliber ( talk · contribs) 00:34, 11 April 2010 (UTC)
Will work the terminology into the article body. The Harrison's source doesn't say where the other substances come from. JFW | T@lk 23:49, 12 April 2010 (UTC)
May as well haul out the green '+' icons then...
1. Well written?:
2. Factually accurate and verifiable?:
3. Broad in coverage?:
4. Reflects a neutral point of view?:
5. Reasonably stable?
6. Illustrated by images, when possible and appropriate?:
Overall:
In addition to BNZs, oral anticoagulants such as coumarins (warfarin) may also cause hepatic encephalopathy. —Preceding unsigned comment added by 92.28.33.151 ( talk) 16:29, 9 May 2010 (UTC)
doi:10.1111/j.1365-2036.2011.04590.x - consensus statement on the design of clinical trials. This is hopeful. Perhaps we'll get some more hard data on the various treatments soon. JFW | T@lk 22:06, 1 October 2011 (UTC)
Small trial, not for inclusion but interesting in case secondary sources appear: doi:10.1136/gutjnl-2012-303262 (PHE score comes out best). JFW | T@lk 20:39, 14 September 2013 (UTC)
Wijdicks doi:10.1056/NEJMra1600561 JFW | T@lk 08:10, 27 October 2016 (UTC)
![]() | This edit request by an editor with a conflict of interest was declined. |
I added the following links in External Links section
These links were removed. After a discussion with user:Doc James I became aware of Wiki’s conflict of interest policy. I hope to navigate that policy carefully.
The first link is a video that I created, and is therefore a conflict of interest for me to post. I would ask that a third party look into the video and decide it’s worthiness.
I receive advertisement fees for videos. This is one of my top videos—and is not likely to see an significant increase in traffic from posting here. I am not allowed to disclose earnings from YouTube, but suffice to say, even if views on this video were to double annually for the next 10 years, I’d still have made less in those years than I would in a week at a part time job. Tmbirkhead ( talk) 05:27, 11 December 2017 (UTC)
I can see no rationality in the responses, so far. I will wait to see what replies come in from the rebuttals that I have posted, but without any request for my response, I am done trying. This was a fools errand. I tried to make Wikipedia a better place, but have, thus far, been prevented from doing that by a group that won’t even take the time to examine the content of my contribution. The contribution I didn’t have to make available to the public, a contribution that doesn’t bring me (nor ever will) great fame or wealth. And I have pointed out to at least some of you the obvious double standard where some YouTube videos are linked with very little (weak) relationship to a primary article, but they are allowed to stay. I honestly have nothing to gain from this other than the satisfaction of knowing that I made the worlds largest encyclopedia a little bit better. And when the historians judge; they will point to the few users above as individuals that (in this case) prevented that improvement. goodnight. Tmbirkhead ( talk) 10:44, 13 December 2017 (UTC)