feat: règles métier T2A Phase 1 — exclusions diagnostiques, sévérité CMA et alertes codage

Ajout des règles d'exclusion symptôme (R00-R99) vs diagnostic précis (Chapitres I-XIV),
détection heuristique de sévérité CMA sur 25 racines CIM-10, et affichage des alertes
de codage dans le viewer Flask. 153 tests, 0 régression.

Co-Authored-By: Claude Opus 4.6 <noreply@anthropic.com>

tests/test_exclusion_rules.py

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+"""Tests pour les règles d'exclusion diagnostique (symptôme vs diagnostic précis)."""
+
+import pytest
+
+from src.config import Diagnostic
+from src.medical.exclusion_rules import (
+    is_symptom_code,
+    is_precise_diagnosis,
+    check_exclusions,
+    EXCLUSION_MAP,
+)
+
+
+class TestIsSymptomCode:
+    def test_r_codes(self):
+        assert is_symptom_code("R10.4") is True
+        assert is_symptom_code("R17") is True
+        assert is_symptom_code("R50.9") is True
+
+    def test_non_symptom(self):
+        assert is_symptom_code("K85.1") is False
+        assert is_symptom_code("I10") is False
+        assert is_symptom_code("E11.9") is False
+
+    def test_empty_none(self):
+        assert is_symptom_code("") is False
+        assert is_symptom_code(None) is False
+
+
+class TestIsPreciseDiagnosis:
+    def test_precise(self):
+        assert is_precise_diagnosis("K85.1") is True
+        assert is_precise_diagnosis("A41.9") is True
+        assert is_precise_diagnosis("I10") is True
+
+    def test_not_precise(self):
+        assert is_precise_diagnosis("R10.4") is False
+        assert is_precise_diagnosis("Z03") is False  # Chapitre XXI
+
+
+class TestCheckExclusions:
+    def test_symptom_excluded_when_precise_present(self):
+        """R10.4 (douleur abdo) exclu quand K85.1 (pancréatite) est présent."""
+        dp = Diagnostic(texte="Pancréatite aiguë biliaire", cim10_suggestion="K85.1")
+        das = [
+            Diagnostic(texte="Douleur abdominale", cim10_suggestion="R10.4"),
+            Diagnostic(texte="Obésité", cim10_suggestion="E66.0"),
+        ]
+        result = check_exclusions(dp, das)
+        assert len(result.cleaned_das) == 1
+        assert result.cleaned_das[0].cim10_suggestion == "E66.0"
+        assert len(result.excluded) == 1
+        assert result.excluded[0].cim10_suggestion == "R10.4"
+        assert len(result.warnings) >= 1
+
+    def test_symptom_kept_when_alone(self):
+        """R10.4 (douleur abdo) conservé si aucun diagnostic précis l'expliquant."""
+        dp = Diagnostic(texte="Douleur abdominale", cim10_suggestion="R10.4")
+        das = [
+            Diagnostic(texte="Hypertension", cim10_suggestion="I10"),
+        ]
+        result = check_exclusions(dp, das)
+        assert len(result.cleaned_das) == 1
+        assert result.cleaned_das[0].cim10_suggestion == "I10"
+        assert len(result.excluded) == 0
+
+    def test_multiple_exclusions(self):
+        """Plusieurs symptômes exclus par différents diagnostics précis."""
+        dp = Diagnostic(texte="Pancréatite aiguë", cim10_suggestion="K85.9")
+        das = [
+            Diagnostic(texte="Douleur abdominale", cim10_suggestion="R10.4"),
+            Diagnostic(texte="Nausées", cim10_suggestion="R11"),
+            Diagnostic(texte="Diabète type 2", cim10_suggestion="E11.9"),
+        ]
+        result = check_exclusions(dp, das)
+        # R10.4 exclu par K85, R11 exclu par K85
+        assert len(result.excluded) == 2
+        assert len(result.cleaned_das) == 1
+        assert result.cleaned_das[0].cim10_suggestion == "E11.9"
+
+    def test_non_symptom_never_excluded(self):
+        """Un diagnostic précis (non R-code) n'est jamais exclu."""
+        dp = Diagnostic(texte="Pancréatite aiguë", cim10_suggestion="K85.1")
+        das = [
+            Diagnostic(texte="Lithiase cholédoque", cim10_suggestion="K80.5"),
+            Diagnostic(texte="Cholécystite", cim10_suggestion="K81.0"),
+        ]
+        result = check_exclusions(dp, das)
+        assert len(result.cleaned_das) == 2
+        assert len(result.excluded) == 0
+
+    def test_dp_symptom_triggers_warning(self):
+        """Alerte si le DP est un symptôme alors qu'un diagnostic précis existe."""
+        dp = Diagnostic(texte="Douleur abdominale", cim10_suggestion="R10.4")
+        das = [
+            Diagnostic(texte="Pancréatite aiguë", cim10_suggestion="K85.1"),
+        ]
+        result = check_exclusions(dp, das)
+        # Le DAS K85.1 n'est pas un symptôme, il est conservé
+        assert len(result.cleaned_das) == 1
+        # Mais un warning est émis sur le DP
+        assert any("ALERTE DP" in w for w in result.warnings)
+
+    def test_warnings_generated(self):
+        """Vérifie que les warnings contiennent le texte et les codes."""
+        dp = Diagnostic(texte="Cholécystite", cim10_suggestion="K81.0")
+        das = [
+            Diagnostic(texte="Fièvre", cim10_suggestion="R50.9"),
+        ]
+        result = check_exclusions(dp, das)
+        assert len(result.excluded) == 1
+        assert "R50.9" in result.warnings[0]
+        assert "K81.0" in result.warnings[0]
+
+    def test_ictere_excluded_by_lithiase(self):
+        """R17 (ictère) exclu quand K80 (lithiase biliaire) est présent."""
+        dp = Diagnostic(texte="Lithiase cholédoque", cim10_suggestion="K80.5")
+        das = [
+            Diagnostic(texte="Ictère", cim10_suggestion="R17"),
+        ]
+        result = check_exclusions(dp, das)
+        assert len(result.excluded) == 1
+        assert result.excluded[0].cim10_suggestion == "R17"

tests/test_severity.py

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+"""Tests pour le module de sévérité heuristique (CMA/CMS)."""
+
+import pytest
+
+from src.config import Diagnostic
+from src.medical.severity import (
+    evaluate_severity,
+    enrich_dossier_severity,
+    _detect_severity_markers,
+    _is_heuristic_cma,
+)
+
+
+class TestDetectSeverityMarkers:
+    def test_severe_markers(self):
+        niveau, marqueurs = _detect_severity_markers("Pancréatite aiguë sévère")
+        assert niveau == "severe"
+        assert any(m in ("severe", "aigue") for m in marqueurs)
+
+    def test_moderate_markers(self):
+        niveau, marqueurs = _detect_severity_markers("Insuffisance rénale modérée")
+        assert niveau == "modere"
+        assert "modere" in marqueurs or "moderee" in marqueurs
+
+    def test_mild_markers(self):
+        niveau, marqueurs = _detect_severity_markers("Anémie chronique bénigne")
+        assert niveau == "leger"
+        assert any(m in ("chronique", "benin", "benigne") for m in marqueurs)
+
+    def test_no_markers(self):
+        niveau, marqueurs = _detect_severity_markers("Hypertension artérielle")
+        assert niveau == "non_evalue"
+        assert marqueurs == []
+
+    def test_severe_overrides_mild(self):
+        """Si 'sévère' et 'chronique' sont présents, 'severe' l'emporte."""
+        niveau, marqueurs = _detect_severity_markers("Insuffisance cardiaque chronique décompensée")
+        assert niveau == "severe"
+
+
+class TestHeuristicCMA:
+    def test_e11_is_cma(self):
+        assert _is_heuristic_cma("E11.9") is True
+
+    def test_i48_is_cma(self):
+        assert _is_heuristic_cma("I48.9") is True
+
+    def test_a41_is_cma(self):
+        assert _is_heuristic_cma("A41.9") is True
+
+    def test_k85_not_cma(self):
+        assert _is_heuristic_cma("K85.1") is False
+
+    def test_i10_not_cma(self):
+        assert _is_heuristic_cma("I10") is False
+
+    def test_empty(self):
+        assert _is_heuristic_cma("") is False
+        assert _is_heuristic_cma(None) is False
+
+
+class TestEvaluateSeverity:
+    def test_cma_code_detected(self):
+        diag = Diagnostic(texte="Diabète type 2", cim10_suggestion="E11.9")
+        info = evaluate_severity(diag)
+        assert info.est_cma_probable is True
+
+    def test_non_cma_code(self):
+        diag = Diagnostic(texte="Pancréatite aiguë biliaire", cim10_suggestion="K85.1")
+        info = evaluate_severity(diag)
+        assert info.est_cma_probable is False
+
+    def test_severity_from_text(self):
+        diag = Diagnostic(texte="Sepsis sévère", cim10_suggestion="A41.9")
+        info = evaluate_severity(diag)
+        assert info.niveau_severite == "severe"
+        assert info.est_cma_probable is True
+
+    def test_combined_text_and_dict_label(self):
+        """Le label du dictionnaire CIM-10 enrichit la détection de sévérité."""
+        diag = Diagnostic(texte="Embolie pulmonaire", cim10_suggestion="I26.9")
+        info = evaluate_severity(diag)
+        assert info.est_cma_probable is True
+
+
+class TestEnrichDossierSeverity:
+    def test_enriches_das_in_place(self):
+        dp = Diagnostic(texte="Pancréatite aiguë biliaire", cim10_suggestion="K85.1")
+        das = [
+            Diagnostic(texte="Fibrillation auriculaire", cim10_suggestion="I48.9"),
+            Diagnostic(texte="Obésité", cim10_suggestion="E66.0"),
+        ]
+        alertes = enrich_dossier_severity(dp, das)
+
+        # I48.9 = CMA probable
+        assert das[0].est_cma is True
+        assert das[0].niveau_severite is not None
+
+        # E66.0 = non CMA
+        assert das[1].est_cma is None
+
+        # Au moins une alerte CMA
+        assert any("CMA" in a for a in alertes)
+
+    def test_dp_severity_set(self):
+        dp = Diagnostic(texte="Sepsis sévère", cim10_suggestion="A41.9")
+        alertes = enrich_dossier_severity(dp, [])
+        assert dp.niveau_severite == "severe"
+        assert dp.est_cma is True