Alkolik Hepatitde Tedavi Algoritması
Özet
Alkolik hepatit (AH), uzun süreli aşırı alkol tüketimi sonucu gelişen, sarılık ve yüksek kısa dönem mortalite riskiyle karakterize akut bir karaciğer hastalığıdır. Hastalığın şiddetini ve prognozunu belirlemede modifiye Maddrey Diskriminant Fonksiyonu (mDF ≥32) ve MELD (>20) skorları klinik kararlarda yaygın şekilde kullanılmaktadır. Genel yönetim stratejisi alkolün tamamen bırakılmasını, yoğun nutrisyonel desteği (2500 Kcal/gün ve 1.2-1.5 g/kg protein) ve enfeksiyon ile akut böbrek hasarı gibi komplikasyonların proaktif tedavisini içerir. Şiddetli AH vakalarında, 28 günlük prednisolon tedavisi veya N-asetilsistein kombinasyonu kısa vadeli mortaliteyi belirgin şekilde azaltırken, kortikosteroid kontrendikasyonu durumunda pentoksifilin alternatif bir seçenek sunar; tedaviye yanıtsız ve uygun hastalarda ise karaciğer transplantasyonu değerlendirilmelidir.
Alcoholic hepatitis (AH) is an acute liver condition induced by chronic excessive alcohol consumption, characterized by severe jaundice and a high risk of short-term mortality. The modified Maddrey Discriminant Function (mDF ≥32) and MELD (>20) scoring systems are widely utilized in clinical practice to evaluate disease severity and guide treatment decisions. Standard management focuses on absolute alcohol abstinence, aggressive nutritional support achieving 2500 Kcal/day and 1.2-1.5 g/kg of protein, alongside proactive prevention of complications like infections and acute kidney injury. For severe cases, specific pharmacological therapy involving a 28-day course of prednisolone or its combination with N-acetylcysteine significantly improves survival rates, whereas pentoxifylline serves as an alternative when steroids are contraindicated, and liver transplantation remains a viable option for eligible, non-responding patients.
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