Critères diagnostiques et bilan initial de la cirrhose non compliquée - Diagnosis of uncomplicated cirrhosis 2006 - Quick reference guide - Version anglaise

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Description

Mis en ligne le 07 mai 2009 Ces recommandations ont pour objectif d'améliorer le diagnostic de la cirrhose non compliquée, afin d’en traiter la cause et les éventuelles comorbidités, et de prévenir ses complications. Elles ont été élaborées suite à la mise à disposition de méthodes «non invasives» de mesure de la fibrose hépatique. Elles tiennent compte des données cliniques et économiques disponibles sur l’ensemble des méthodes diagnostiques (ponction biopsie hépatique, élastographie impulsionnelle ultrasonore et scores biologiques composites).Elles définissent la démarche diagnostique de la cirrhose non compliquée et abordent les points suivants :circonstances diagnostiques et populations ciblesexamens biologiques nécessaires au diagnosticconsultation spécialisée et confirmation du diagnosticbilan initial, étiologique et de sévérité. Mis en ligne le 07 mai 2009

Sujets

• Économie de la santé

Informations

• Publié par: haute-autorite-sante-maladies-appareil-digestif
• Publié le: 07 mai 2009
• Nombre de lectures: 14
• Licence : En savoir +
  Paternité, pas d'utilisation commerciale, partage des conditions initiales à l'identique
• Langue: English

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QUICK REFERENCE GUIDE

DIAGNOSIS OF UNCOMPLICATED CIRRHOSIS  

The World Health Organisation defines cirrhosis as a diffuse process characterised by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules.   The following guidelines concern uncomplicated cirrhosis only, i.e. the stage of the disease when patients have few or no symptoms.      IN CAUSES OF LIVER DISEASE      of alcohol over a long periodExcessive consumption  Chronic hepatitis C virus (HCV) infection  Metabolic syndrome  Chronic hepatitis B virus (HBV) infection   Genetic haemochromatosis   Autoimmune diseases (particularly primary biliary cirrhosis)      

TYPES OF ABNORMALITIES SUGGESTING CIRRHOSIS

   Clinical (hard liver, spider angioma, splenomegaly)  Biological (thrombopenia, reduction in prothrombin time)  Endoscopic (œsophageal varices)  Imaging (irregular liver surface, liver atrophy or hypertrophy, signs of portal hypertension)   BIOLOGICAL TESTS BEFORE REFERRING THE PATIENT TO A SPECIALIST     Haemogram    ASAT,Bilirubin (total), serum ALAT,ΧGT and alkaline phosphatase  Protein electrophoresis  Prothrombin time  Glucose, triglycerides, cholesterol  Ferritin and transferrin saturation coefficient  HBs antigen, anti-HBs and anti-HBc antibodies  Anti-HCV antibodies

  DIAGNOSTIC TOOLS TO CONFIRM THE DIAGNOSIS

   Chronic untreated hepatitis C patients with no comorbidities:   1 st line test: a non-invasive procedure (Fibroscan ® or Fibrotest ® )   2 nd line test: a second non-invasive procedure and/or a liver biopsy  Other patients: a liver biopsy     PRINCIPLE LIMITATIONS   · Use appropriate assay techniques;   Composite score:  ensure proper quality control and age, gender and 5  specimen storage biomarkers ( - · Interpret results with caution: no Fibrotest ®   macroglobuli a llentni nip ss ,inurreterc ,  lacutia 2 r n  nor  haptoglobin, acute  inflammation, haemolysis, apolipoprotein A1,  Gilbert’s syndrome, no taking of bilirubin (total),Χ  causing elevated bilirubinGT) medicines levels Ultrasound technique · Equipment installed in only a few   measuring the speed  centres in France Transient elasto raph ine av w he t of propagtaoi nfoa   hra · Does not provide a reliable result in (Fibroscan ® ) s e   obese patients or in patients, such as liver (“liver stiffness”)  children, with a narrow intercostal s ace     Sampling errors may give rise to false ·  negatives (specimen too small); inter- observer and intra-observer variations Histological  examination · Constraints due to stay in hospital and Liver biopsy to precautions to be taken before performing the procedure · Risk of complications (especially bleeding)  

INITIAL STATEMENT OF CIRRHOSIS

Biological tests

Morphological examinations

 ·

 ·  ·  ·  · ·  

Bilirubin (total), serum ASAT, ALAT,ΧGT and alkaline phosphatase Prothrombin time, albumin  Haemogram a%foeto rotein Abdominal Doppler ultrasound by an experienced operator Oeso ha eal, astric and duodenal endosco            

SEVERITY OF CIRRHOSIS

   

Child-Pugh score  

Hepatic encephalopathy Ascites

Bilirubin (total) (mmol/l)

Serum Albumin (g/l)

Prothrombin ratio (%)

1 point

None None

< 35

35 >

2 points

Grade I and II Slight

35 -50

28 - 35

   

3 points

Grade III and IV Moderate

> 50

< 28

> 50 40 - 50 < 40    J, McIn N, R S i o z u z r e c tt e o  :     M E , r   li R n o g d e è r  s  S J , .     B H e é n p h a a to m lo o g u i   e J  c P l . i   ni C q ir u r e h , o  2 s i e è   m : e é iditno ,idirég par Jean-PierreB neahom.uP rasi: Flammarion  yter .seuqinhneB :nIP, Jouamerchir Bcestc ila ps Médecine-Sciences; 2002. p. 629-41.   Ó2002 Flammarion Médecine-Sciences   The higher the score, the more severe the disease (class A: 5-6 points; class B: 7-9 points; class C: 10-15 points).                                           This Quick Reference Guide is an English summary of the main points of the French guidelines: “Critères diagnostiques et bilan initial de la cirrhose non compliquée” , October 2006. The full guidelines and supporting document (in French) can be found atwww.has-sante.fr