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Hépato-Gastro & Oncologie Digestive

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Hepatic cytolysis (aminotranferases increase) in adults Volume 20, issue 8, Octobre 2013

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Centre hospitalier, unité d’hépatogastroentérologie, boulevard Hauterive, 64000 Pau, France

<p>Increase in serum aminotransferases is a daily diagnostic problem in hepatology. The term « cytolysis » should be abandoned since aminotransferases elevation is common in cholestasis, and is not synonymous for hepatocyte necrosis. On an arbitrarily basis, one can distinguish marked, usually acute increases (>15 times the upper limit of normal values), and minimal to moderate, usually chronic ones (<10 times the upper limit of normal values).</p><p>The main causes of aminotransferases increases are rhabdomyolysis, hypoxic hepatitis, acute biliary obstruction, acute hepatitis (viral, toxic or drug-induced), autoimmune hepatitis; Budd-Chiari syndrome, Wilson's disease, anorexia nervosa and glycogenic hepatopathy.</p><p>The main causes of minimal to moderate, usually chronic aminotransferases increase are alcoholic liver diseases, non alcoholic fatty liver diseases, chronic viral hepatitis, chronic toxic and drug-induced livre diseases, auto-immune hepatitis, hemochromatosis, Wilson's disease, vascular liver diseases, α1-antitrypsin deficiency. Extra hepatic causes are frequent (myopathies, thyroid dysfunctions, coelic disease, adrenal insufficiency).</p><p>The diagnosis rests on clinical data (interview in the first place), biological descrambling tests and abdominal ultrasonography. Complementary tests are necessary to confirm the first hypotheses or look for rare causes. Liver biopsy is necessary when its results are essential for the management of the causal disease, when several potential causes are associated, and when no cause has been recognized (elastometry should – could – precede liver biopsy in this last situation).</p>