Akut Karaciğer Yetmezliği
Özet
Akut karaciğer yetmezliği (AKY), önceden karaciğer hastalığı olmayan bireylerde koagülopati ve ensefalopati ile karakterize, nadir ancak ölümcül bir klinik tablodur. Hastalık; hiperakut, akut ve subakut olmak üzere üç kategoride sınıflandırılır. Etiyolojisinde gelişmiş ülkelerde en sık neden asetaminofen (parasetamol) zehirlenmesi iken, gelişmekte olan bölgelerde viral hepatitler (HAV, HBV, HEV) ön plandadır. Ayrıca ilaç reaksiyonları, mantar zehirlenmesi ve Wilson hastalığı gibi nadir nedenler de AKY'ye yol açabilir. Klinik seyirde serebral ödem, intrakraniyal hipertansiyon, sepsis ve böbrek yetmezliği gibi ciddi komplikasyonlar gelişebilir. Serebral ödem, özellikle amonyak artışına bağlı olarak ortaya çıkar ve AKY'deki temel ölüm nedenidir. Tanıda laboratuvar testleri ve prognostik modeller (King’s College kriterleri, MELD skoru) hayati öneme sahiptir. Tedavi yaklaşımı; erken teşhis, yoğun bakım desteği ve uygun vakalarda acil karaciğer transplantasyonunu kapsar. Karaciğer nakli, sağkalım oranlarını %60'ın üzerine çıkarmıştır. Nakil öncesi köprü görevi gören ekstrakorporal destek sistemleri (MARS, plazma değişimi) de güncel tedavide yer almaktadır.
Acute liver failure (ALF) is a rare but fatal clinical condition characterized by coagulopathy and encephalopathy in individuals without prior liver disease. The disease is classified into three categories: hyperacute, acute, and subacute. Regarding etiology, acetaminophen (paracetamol) poisoning is the most common cause in developed countries, while viral hepatitides (HAV, HBV, HEV) predominate in developing regions. Additionally, rare causes such as drug reactions, mushroom poisoning, and Wilson's disease can also lead to ALF. Severe complications like cerebral edema, intracranial hypertension, sepsis, and renal failure may develop during the clinical course. Cerebral edema, primarily arising due to increased ammonia levels, is the leading cause of death in ALF. Laboratory tests and prognostic models (King’s College criteria, MELD score) are vital for diagnosis. The treatment approach includes early diagnosis, intensive care support, and emergency liver transplantation in appropriate cases. Liver transplantation has increased survival rates to over 60%. Extracorporeal support systems (MARS, plasma exchange), which serve as a bridge to transplantation, are also utilized in current therapy.
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