\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Alkol al\u0131m\u0131 y\u00fczy\u0131llar boyunca insanl\u0131\u011f\u0131n ilgi oda\u011f\u0131 ve sorunu olmu\u015ftur. Ki\u015filerin gelirlerinin ve refah d\u00fczeylerinin artmas\u0131 alkole ula\u015fmay\u0131 kolayla\u015ft\u0131rmakta ve artt\u0131rmaktad\u0131r. \u00d6te yandan \u00fcz\u00fcnt\u00fcler ve stres de alkol kullan\u0131m\u0131n\u0131 artt\u0131rmaktad\u0131r. Bu, daha sonra y\u00fcksek doz alkol al\u0131m\u0131n\u0131 ve alkol ba\u011f\u0131ml\u0131l\u0131\u011f\u0131n\u0131 ortaya \u00e7\u0131karmaktad\u0131r. Bunun sonucunda alkole ba\u011fl\u0131 karaci\u011fer, pankreas ve mide, barsak hastal\u0131klar\u0131\u00a0 gelir. Bunlar i\u00e7inde en \u00f6nemli ve pop\u00fcler olan\u0131 alkole ba\u011fl\u0131 karaci\u011fer hastal\u0131klar\u0131d\u0131r.<\/p>\n
\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0Alkol kullan\u0131m\u0131n\u0131n karaci\u011fer hastal\u0131klar\u0131na yol a\u00e7t\u0131\u011f\u0131 y\u00fczy\u0131llard\u0131r bilinmektedir. Bug\u00fcn i\u00e7in alkol kullan\u0131m\u0131 ile ya\u011fl\u0131 karaci\u011fer (karaci\u011fer ya\u011flanmas\u0131), Alkolik hepatit ve siroz gibi karaci\u011fer hastal\u0131klar\u0131 aras\u0131ndaki ili\u015fki iyice ara\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. Ya\u011fl\u0131 karaci\u011fer alkol (etanol) kullan\u0131m\u0131n\u0131n b\u0131rak\u0131lmas\u0131 ile geriye d\u00f6nebilen selim bir durumdur. Ancak hastada alkolik hepatit geli\u015fmi\u015f\u00a0 ise bu, tedavi gerektiren daha ciddi bir sorundur; gerekli tedavi yap\u0131lamazsa siroza kadar ilerleyebilir. Siroz geli\u015fmi\u015f ise; bu son d\u00f6nem karaci\u011fer hastal\u0131\u011f\u0131d\u0131r, tedavi g\u00f6rmeyenlerde k\u0131sa s\u00fcrede hastada portal Hipertansiyon komplikasyonlar\u0131, karaci\u011fer yetmezli\u011fi geli\u015febilir ve sonunda \u00f6l\u00fcme yol a\u00e7ar.<\/p>\n
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Alkol\u00fcn karaci\u011fer hastal\u0131\u011f\u0131na yol a\u00e7mas\u0131n\u0131n nedeni % 90’\u0131ndan fazlas\u0131n\u0131n karaci\u011ferde metabolize olmas\u0131d\u0131r. Midenin ihmal edilebilir k\u00fc\u00e7\u00fck katk\u0131s\u0131n\u0131 g\u00f6z ard\u0131 edersek, alkol metabolizmas\u0131nda as\u0131l sorumlu olan organ karaci\u011ferdir. Alkol\u00fcn kronik karaci\u011fer hastal\u0131\u011f\u0131na (siroz) yol a\u00e7an \u00f6nemli nedenlerden biri oldu\u011fu bilinmektedir. Ancak a\u015f\u0131r\u0131\u00a0 alkol t\u00fcketen ki\u015filerin hepsinde siroz geli\u015fmez. Alkoliklerin sadece % 0-20’sinde siroz geli\u015fti\u011fi\u00a0 g\u00f6r\u00fclmektedir. Ni\u00e7in alkol alanlar\u0131n \u00f6nemli\u00a0 bir k\u0131sm\u0131nda alkolik karaci\u011fer hastal\u0131\u011f\u0131 geli\u015fmezken sadece bir k\u0131s\u0131m hastada, belki de daha az alkol ald\u0131klar\u0131 halde karaci\u011fer sirozuna kadar varan alkolik karaci\u011fer hasar\u0131 geli\u015fmektedir? Bu durumdan, alkol metabolizmas\u0131nda rol alan enzimlerdeki genetik de\u011fi\u015fiklikler sorumlu tutulmaktad\u0131r.<\/p>\n
Erkeklerde siroz geli\u015fimi i\u00e7in g\u00f6rece risk 20gr\/g\u00fcn alkol t\u00fcketenlere g\u00f6re 80gr\/g\u00fcn t\u00fcketenlerde 14 kat, 40-60 gr t\u00fcketenlerde 6 kat daha fazlad\u0131r.80 gr.\u0131n kar\u015f\u0131l\u0131\u011f\u0131 5 \u015fi\u015fe bira ya da 1lt \u015farap\/g\u00fcn d\u00fcr.Alkol\u00fcn t\u00fcr\u00fc \u00f6nemli olmay\u0131p, \u00f6nemli olan i\u00e7eri\u011findeki alkol miktar\u0131d\u0131r. Alkol\u00fc s\u00fcrekli alanlar daha \u00e7ok risk alt\u0131nda olmakla birlikte, e\u015fik de\u011fer \u00f6nemlidir. kad\u0131nlar alkole erkeklerden daha duyarl\u0131d\u0131r. Cins fark\u0131 menapozdan sonra kaybolur.A\u011f\u0131z yolundan al\u0131nd\u0131\u011f\u0131nda 5 dk.da kanda belirir. Al\u0131nan alkol\u00fcn % 20′ si mideden emilir. Ama ince barsaktan emilim h\u0131z\u0131 daha fazlad\u0131r.Maksimum kan konsantrasyonuna 40-60 dk.da ula\u015f\u0131r. Alkol a\u011f\u0131z yolundan al\u0131nd\u0131\u011f\u0131nda kal\u0131n barsa\u011fa ula\u015famaz. Plasentadan fetal kana kolayca ge\u00e7er. Fet\u00fcs ve anne kan\u0131nda konsantrasyonlar\u0131 e\u015fittir.1 gr alkol 7 gr kalori verir. Fakat verdi\u011fi kalori yaln\u0131zca enerjidir. Beslenmeye katk\u0131s\u0131 yoktur.<\/p>\n
V\u00fccuda giren alkol\u00fcn % 98′ i biyotransformasyona u\u011frar. % 2′ lik k\u0131s\u0131m akci\u011ferlerden solunumla veya b\u00f6breklerden idrarla at\u0131l\u0131r. Bu nedenle solunumla d\u0131\u015far\u0131 verilen Havadaki Alkol, al\u0131nan alkol\u00fc \u00e7ok k\u0131sa s\u00fcrede aynen yans\u0131t\u0131r. Kan ve solunum havas\u0131ndaki oran 1:1300’d\u00fcr. normal bir kimse Saatte 150 mg\/kg alkol\u00fc metabolize edebilir. Bu da 1 saatte ortalama 50 ml (70′ lik rak\u0131n\u0131n 1\/14′ \u00fc) rak\u0131ya e\u015fde\u011ferdir.<\/p>\n
Ara\u00e7 kullananlarda alkol s\u0131n\u0131r\u0131 \u00fclkeden \u00fclkeye de\u011fi\u015fir. \u0130ngiltere gibi baz\u0131 \u00fclkelerde bu s\u0131n\u0131r 80mg\/dl iken, bizde oldu\u011fu gibi baz\u0131 \u00fclkelerde ise 50mg\/dl'(50 promil) dir.<\/p>\n
\u00a0Alkolik karaci\u011fer hastal\u0131\u011f\u0131nda 3 ana hastal\u0131k evresi vard\u0131r:<\/p>\n
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 -Ya\u011fl\u0131 karaci\u011fer (steatozis)<\/p>\n
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 -Alkolik hepatit<\/p>\n
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 -Alkolik fibrozis ve\/veya siroz<\/p>\n
Ya\u011fl\u0131 karaci\u011fer k\u0131sa s\u00fcreli alkol al\u0131m\u0131 sonucu olu\u015furken, hepatit ve fibrozis uzun s\u00fcreli alkol al\u0131m\u0131 sonras\u0131nda olu\u015fur.<\/p>\n
Alkol al\u0131m\u0131ndaki biyokimyasal de\u011fi\u015fiklikler, alkol i\u00e7in spesifik olmamakla birlikte alkol\u00fcn metabolik ve toksik etkilerini yans\u0131t\u0131r.GGT: Alkol al\u0131\u015fkanl\u0131\u011f\u0131nda g\u00f6r\u00fclen en yayg\u0131n biyokimyasal de\u011fi\u015fikliktir. Bu Enzim karaci\u011fer k\u00f6kenli olup, alkol al\u0131m\u0131yla ind\u00fcklenir. Baz\u0131 \u00e7al\u0131\u015fmalarda kronik alkol kullan\u0131m\u0131 olanlarda GGT % 80-90 aras\u0131nda y\u00fcksek bulunmu\u015ftur. GGT ortalama olarak 2-3 kat y\u00fcksek bulunmakla birlikte, genellikle 5 kata kadar y\u00fckselir.\u00a0 Alkol kesildikten 2 hafta sonra azalmaya ba\u015flar ve 5 hafta kadar sonra normal de\u011ferlerine ula\u015f\u0131r. GGT’nin serumdaki oran\u0131 karaci\u011ferdeki hasar ile do\u011frudan ili\u015fkilidir.<\/p>\n
\u015eekil 1: Alkol kullananlarda olu\u015fan karaci\u011fer hastal\u0131klar\u0131n\u0131n oran\u0131<\/p>\n
Alkolik Hepatit<\/p>\n
Alkolik hepatite hem hastada olu\u015fan belirtiler (klinik) hem de karaci\u011fer biyopsisi sonucu ile karar verilir.\u00a0 A\u011f\u0131r alkol kullan\u0131m hikayesi olan, uygun klinik ve laboratuvar bulgular\u0131 ta\u015f\u0131yan bir hastada alkolik hepatitten \u015f\u00fcphelenilir. Klinik ve laboratuvar \u00f6zellikleri, tan\u0131y\u0131 koymak i\u00e7in s\u0131kl\u0131kla yeterlidir ancak tan\u0131, karaci\u011fer biyopsisi ile kan\u0131tlanabilir.<\/p>\n
Dikkatli bir hikaye, bu durumda mutlakt\u0131r. \u00d6nemli bilgiler; alkol al\u0131m\u0131n\u0131n miktar\u0131 ve s\u00fcresini, hepatit B veya C i\u00e7in muhtemel risk fakt\u00f6rlerinin varl\u0131\u011f\u0131n\u0131 (transf\u00fczyon, i\u011fne kullan\u0131m\u0131, multipl partnerle korunmas\u0131z seks), potansiyel olarak hepatotoksik ila\u00e7 kullanm\u0131n\u0131 ve daha \u00f6nce var olan karaci\u011fer hastal\u0131\u011f\u0131 hakk\u0131ndaki bilgileri i\u00e7erir. Alkolik\u00a0 hepatit, tipik olarak serum alkalen fosfataz (ALP) ve GGT’de art\u0131\u015f ve hiperbilirubinemi ile ili\u015fkilidir. Bu de\u011fi\u015fiklikler, karaci\u011fer enzimleri (ALT, AST) normale d\u00f6nd\u00fckten sonra haftalarca devam edebilir.<\/p>\n
Karaci\u011fer Sirozu<\/p>\n
Alkolik siroz geli\u015fimi\u00a0 alkol al\u0131m\u0131n\u0131n s\u00fcresi ve miktar\u0131 ile \u00e7ok yak\u0131n ili\u015fkilidir. Erkeklerde g\u00fcnl\u00fck 20 gram alkol alanlar ile\u00a0 40-60 gr\/g\u00fcn\u00a0 alkol alanlar aras\u0131nda sirozun relatif riski 6 kez daha fazlayd\u0131.G\u00fcnl\u00fck alkol al\u0131m\u0131 60-80 gram olanlarda ise bu risk 14 kez daha fazlad\u0131r. Siroza neden olan ortalama doz, d\u00fczenli olarak yakla\u015f\u0131k 25 y\u0131l alkol alanlarda 180 gr\/g\u00fcn\u00a0 etanol olarak hesap edilmi\u015ftir. Alkol ve karaci\u011fer hastal\u0131klar\u0131\u00a0 aras\u0131ndaki\u00a0 ili\u015fki en az iki as\u0131rd\u0131r bilinmektedir. Son senelerde alkol t\u00fcketimi\u00a0 artt\u0131k\u00e7a alkole ba\u011fl\u0131 karaci\u011fer\u00a0 hastal\u0131klar\u0131n\u0131n g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 da artmaktad\u0131r. <\/p>\n
Son 20 senede\u00a0 alkol t\u00fcketimiyle siroza ba\u011fl\u0131 \u00f6l\u00fcmler\u00a0 aras\u0131nda do\u011fru orant\u0131 tespit edilmi\u015ftir. Alkolik karaci\u011fer hastal\u0131\u011f\u0131 geli\u015fenlerde haz\u0131rlay\u0131c\u0131 fakt\u00f6rler kesin belli olmamakla birlikte\u00a0 i\u00e7ilen alkol\u00fcn miktar\u0131 ve s\u00fcresi en \u00f6nemli nedendir. Kad\u0131nlar alkol\u00fc b\u0131raksalar dahi\u00a0 mevcut olan alkolik hepatit , siroza daha kolay ilerler.Alkol al\u0131\u015fkanl\u0131\u011f\u0131 ve alkolik karaci\u011fer hastal\u0131\u011f\u0131na olan e\u011filim ebeveynden de intikal etmekle beraber , bundan sorumlu herhangi bir gen g\u00f6sterilememi\u015ftir.<\/p>\n
Alkolik sirozun klinik ve laboratuvar \u00f6zellikleri, b\u00fcy\u00fck \u00f6l\u00e7\u00fcde sirozun di\u011fer nedenlerinde g\u00f6r\u00fclenlere benzer, farkl\u0131 olarak etkilenen hastalar birlikte alkolik hepatitin \u00f6zelliklerini de ta\u015f\u0131yabilir. Serum AST \/ ALT’nin artm\u0131\u015f oran\u0131, sar\u0131l\u0131k, ALP art\u0131\u015f\u0131 ve kan\u00a0 anormallikleri kronik karaci\u011fer hastal\u0131\u011f\u0131n\u0131n klasik bulgular\u0131 ile birlikte olabilir. Sentez bozuklu\u011fu bulgular\u0131 ve belki bilin\u00e7 bulan\u0131kl\u0131\u011f\u0131 (karaci\u011fer komas\u0131) g\u00f6r\u00fclebilir.<\/p>\n
HAZIRLAYAN; Dr. Zafer BUYRA\u00c7<\/p>\n
KAYNAKLAR1-\u0130lter Tankut, Tekin Fatih, Alkol metabolizmas\u0131, G\u00fcncel gastroenteroloji, Mart 2005, s.58-62, 2-Yamada Textbook of Gastroenterology 4th Edition 3-\u015eahin \u00c7oban, Ali \u00d6zden, Alkolik karaci\u011fer hastal\u0131\u011f\u0131nda klinik bulgular ve tan\u0131, G\u00fcncel gastroenteroloji, Haziran 2002, s.76-81<\/p>\n","protected":false},"excerpt":{"rendered":"
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Alkol al\u0131m\u0131 y\u00fczy\u0131llar boyunca insanl\u0131\u011f\u0131n ilgi oda\u011f\u0131 ve sorunu olmu\u015ftur. Ki\u015filerin gelirlerinin ve refah d\u00fczeylerinin artmas\u0131 alkole ula\u015fmay\u0131 kolayla\u015ft\u0131rmakta ve artt\u0131rmaktad\u0131r. \u00d6te yandan \u00fcz\u00fcnt\u00fcler ve stres de alkol kullan\u0131m\u0131n\u0131 artt\u0131rmaktad\u0131r. Bu, daha sonra y\u00fcksek doz alkol al\u0131m\u0131n\u0131 ve alkol ba\u011f\u0131ml\u0131l\u0131\u011f\u0131n\u0131 ortaya \u00e7\u0131karmaktad\u0131r. Bunun sonucunda alkole ba\u011fl\u0131 karaci\u011fer, pankreas ve mide, barsak hastal\u0131klar\u0131\u00a0 gelir. Bunlar i\u00e7inde en \u00f6nemli ve pop\u00fcler[Devam\u0131n\u0131 Oku…]<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[22524],"tags":[23246,23243],"_links":{"self":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13258"}],"collection":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/comments?post=13258"}],"version-history":[{"count":0,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13258\/revisions"}],"wp:attachment":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/media?parent=13258"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/categories?post=13258"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/tags?post=13258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}