Siroz
Özet
Karaciğer sirozu; hepatosellüler nekroz, nodüler rejenerasyon ve fibrozis ile seyreden kronik ve ilerleyici bir son evre karaciğer hastalığıdır. Dünya genelinde sosyo-ekonomik yapılara göre etiyolojisi değişmekle birlikte, ülkemizde en sık karşılaşılan neden viral hepatitler (özellikle HBV) iken, Batı ülkelerinde alkol tüketimi ön plana çıkmaktadır. Hastalık patogenezinde disse aralığında kolajen birikimi, vasküler baypaslar ve rejenerasyon nodüllerinin merkezinde tekrarlayan nekrozlar kritik rol oynar. Klinik tablo temel olarak hepatosellüler yetmezlik ve portal hipertansiyona bağlı gelişerek asit, spontan bakteriyel peritonit, hepatorenal sendrom, hepatik ensefalopati ve hepatosellüler karsinom gibi ölümcül komplikasyonlara yol açabilir. Tanı aşamasında ultrasonografi, laboratuvar testleri, Child-Pugh evrelendirmesi ve histopatolojik incelemeler kullanılır. Hastaların takibinde AST ve ALT seviyeleri aktiviteyi belirlerken, klinik olarak asit ve sarılık gibi dekompanse bulguların varlığı mortaliteyi ciddi oranda artırır. Tedavi yaklaşımı esas olarak mevcut semptomları hafifletmeye ve gelişen komplikasyonları yönetmeye yönelik olup, hastalığın nihai ve en etkili kalıcı tedavi yöntemi karaciğer transplantasyonudur.
Liver cirrhosis is a chronic, progressive, and end-stage disease characterized by hepatocellular necrosis, nodular regeneration, and diffuse fibrosis. While its etiology varies globally based on socio-economic and cultural factors, viral hepatitis (predominantly HBV) is the primary cause in Turkey, whereas chronic alcohol consumption is more prevalent in Western Europe and North America. The pathogenesis involves collagen deposition within the Space of Disse, vascular shunts, and a continuous cycle of necrosis and regeneration that alters the hepatic architecture. Clinical manifestations arise from hepatocellular insufficiency and portal hypertension, leading to life-threatening complications such as ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy, and hepatocellular carcinoma. Diagnosis is established through ultrasonography, biochemical evaluations, Child-Pugh scoring, and histopathological liver biopsy. Patients with decompensated findings like jaundice or ascites face a significantly higher mortality rate, with a 50% five-year survival chance once liver failure develops. Current medical management focuses heavily on symptomatic relief and preventing further complications, while orthotopic liver transplantation remains the definitive and most effective therapeutic solution.
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