Siroz ve Komplikasyonları
Özet
Siroz, kronik karaciğer hastalıklarının son ortak aşamasını temsil eden, yaygın fibrozis, rejeneratif nodül oluşumu ve karaciğer mimarisinin bozulması ile karakterize ilerleyici bir hastalıktır. Günümüzde kronik viral hepatitler, metabolik disfonksiyon ilişkili steatotik karaciğer hastalığı (MASLD/MASH) ve alkol ilişkili karaciğer hastalığı sirozun başlıca nedenlerini oluşturmaktadır. Hastalığın klinik seyri kompanse ve dekompanse evreler şeklinde değerlendirilmekte olup, portal hipertansiyon gelişimi doğal seyrin en önemli belirleyicisidir. Portal hipertansiyon sonucunda özofagus ve gastrik varisler, asit, spontan bakteriyel peritonit, hepatik ensefalopati, hepatorenal sendrom ve diğer yaşamı tehdit eden komplikasyonlar ortaya çıkabilmektedir. Güncel yaklaşım komplikasyonların tedavisinden çok dekompansasyonun önlenmesine, klinik olarak anlamlı portal hipertansiyonun erken tanınmasına ve yaşam kalitesinin korunmasına odaklanmaktadır. Düzenli hepatoselüler karsinom taraması, beslenme desteği, sarkopeni ile mücadele ve uygun zamanda karaciğer transplantasyonu değerlendirmesi modern siroz yönetiminin temel bileşenlerini oluşturmaktadır.
Cirrhosis represents the final common pathway of chronic liver diseases and is characterized by diffuse fibrosis, regenerative nodule formation, and distortion of the normal hepatic architecture. Chronic viral hepatitis, metabolic dysfunction-associated steatotic liver disease (MASLD/MASH), and alcohol-related liver disease are currently among the leading causes of cirrhosis worldwide. The disease course is generally classified into compensated and decompensated stages, with portal hypertension serving as the key determinant of clinical progression. Portal hypertension may lead to life-threatening complications including esophageal and gastric varices, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, and acute-on-chronic liver failure. Contemporary management focuses not only on treating complications but also on preventing decompensation, identifying clinically significant portal hypertension at an early stage, and improving quality of life. Regular hepatocellular carcinoma surveillance, nutritional optimization, management of sarcopenia, and timely liver transplantation assessment are essential components of modern cirrhosis care.
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