Diagnostic des hépatopathies et de leur sévérité

Diagnosis and prognosis of liver diseases are considered here in the context of surgery. When a chronic liver disease is suspected by clinical signs or abnormal liver function tests, the degree of liver fibrosis has to be evaluated. The most accurate markers to assess clinically significant fibrosis in clinical practice are now prothrombin index and serum hyaluronate. The diagnostic accuracy for cirrhosis approaches 90% using non invasive means. The most accurate signs are in clinics: firm liver, in laboratory tests: thrombopenia, decreased prothrombin index and increased hyaluronate, with ultrasonography-Doppler: increased portal diameter and decreased portal velocity and with endoscopy: esophageal varices (but this not a true non-invasive tool). Improvement by blood fibrosis markers and ultrasonography-Doppler are awaited. Child-Pugh score is the most used prognostic score in clinical practice and trials. This is due to its simplicity but some limitations are known. Therefore, other scores are used: APACHE III ou MELD in surgery or resuscitation, Maddrey's score in alcoholic hepatitis and Mayo Clinic's scores in cholestatic diseases.     

Données récentes sur l'homocystéine

New data about homocysteine. Homocysteine, a sulfur-containing aminoacid formed from the transmethylation of the methionin, has been shown to be a risk factor for cardiovascular diseases. Plasma homocysteine value is modulated by physiological (age, sex), nutritional (vitamin status), genetic and pathological factors. Hypermomocysteinemia is responsible for both damaging connective tissue and endothelial cells, and activating coagulation factors. Plasma homocysteine is measured by high performance liquid chromatography, gas chromatographic-mass spectrometric, quantitative amino acid analysis, fluorescence polarization assay technique and radioimmuno-assay.