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Özellikle tıp öğrencileri ve sağlık profesyonelleri için tanı kriterleri, laboratuvar bulguları ve fibroz skorları gibi pratik bilgiler sunulmaktadır."]},"endTime":4007,"title":"Non-Alkolistik Yağlı Karaciğer Hastalığı (NAFLD/NASH) Eğitim Videosu","beginTime":0}],"fullResult":[{"index":0,"title":"Giriş ve Program Hakkında Bilgiler","list":{"type":"unordered","items":["Sunucular, teknik sorunlarla boğuştuklarını ve bilgisayarı satmak zorunda kaldıklarını belirtiyor.","Programda Emrullah Hoca ile beraber metabolik disfunction konusunu ele alacaklar.","Bu, \"Fizyolojiden Tedaviye\" serisinin sekizinci videosu olup, toplamda yirmi-yirmibeş video çekmişler."]},"beginTime":1,"endTime":111,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1&ask_summarization=1"},{"index":1,"title":"Programın Amacı ve 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obez olmak zorunda değil, yorgunluk ve halsizlikle başlar."]},"beginTime":194,"endTime":369,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=194&ask_summarization=1"},{"index":3,"title":"Karaciğerin Anatomi ve Histolojisi","list":{"type":"unordered","items":["Patologlar karaciğer biyopsisinde ilk olarak portal ve santral venleri ararlar.","Portal vena, portal alakalarda bulunur ve bu bölgeye \"zona 1\" denir.","Santrallerin çevresinde \"zona 3\", aralarda \"zona 2\" bulunur."]},"beginTime":369,"endTime":446,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=369&ask_summarization=1"},{"index":4,"title":"Nike ve Alkolik Epati'nin Histolojik Özellikleri","list":{"type":"unordered","items":["Nike ve alkolik epati başlangıçta \"zona 3\" nekrozu ile başlar.","Viral hepatitler ve metabolik karaciğer hastalıkları \"zona 1\" de hasar yaparlar.","Pediatrik Nike olgularında farklı olarak \"zona 1\" tutumu ön plandadır."]},"beginTime":446,"endTime":572,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=446&ask_summarization=1"},{"index":5,"title":"Karaciğer Biyopsi Bulguları","list":{"type":"unordered","items":["Karaciğer biyopsisinde balonlaşma dejenerasyonu, toz kolestaz, konsilman cisim ve doktorlar reaksiyon gibi önemli bulgular görülebilir.","Balonlaşma dejenerasyonu, karaciğerin balon gibi şişmesi olarak tanımlanır ve özellikle alkolik hepatit, nan alkolik hepatit ve alkolik yağlı karaciğer hastalıklarında gözlenir.","Karaciğer biyopsisinde stat (makro ve mikro vezikler), fibroz ve kolestaz gibi bulgular görülebilir."]},"beginTime":584,"endTime":654,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=584&ask_summarization=1"},{"index":6,"title":"Fibroz Tanımlama ve Karşılaştırmalar","list":{"type":"unordered","items":["Karaciğerdeki fibrozi tespit etmek için patologlar tri-krom boyası kullanır ve bu boyayla fibroz mavi görünümlere sahiptir.","Makro vezikler, alkol, hepatit C ve bazı ilaçlarla ilişkilendirilebilir, ancak Nike hastalarında bu bulguların alkol kullanımıyla ilişkili olabileceği unutulmamalıdır.","Mikro vezikler, alkol, Reis sendromu, gebeliğin akut karaciğer hastalığı ve bazı ilaçlarla ilişkilendirilebilir."]},"beginTime":654,"endTime":735,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=654&ask_summarization=1"},{"index":7,"title":"Alkol Kullanımı ve Nike Hastalığı","list":{"type":"unordered","items":["Nike hastalarında alkol kullanımı sorgulanmalı ve haftalık alkol tüketimi değerlendirilmelidir.","Günde yaklaşık 20 gram alkol (1,5-2 bardak bira veya bir bardak şarap) aşımı alkolik hastalık riskine girmeye başlar.","Nike, metabolik toksik bir hastalık olarak tanımlanır ve yağlı karaciğerle başlayan, siroza kadar ilerleyebilen bir hastalık spektrumudur."]},"beginTime":735,"endTime":1099,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=735&ask_summarization=1"},{"index":8,"title":"Nike Hastalığının Risk Faktörleri","list":{"type":"unordered","items":["Nike hastaları genellikle obezite ve metabolik sendrom ile ilişkilidir.","Son yıllarda yüksek kalorili yiyecek tüketimi, fruktoz zengin beslenme ve düşük egzersiz, Nike hastalığının riskini artırır.","Nike hastalarında özellikle viseral (abdömlü) obezite görülür ve bu obezite disfonksiyonel olabilir."]},"beginTime":1099,"endTime":1164,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1099&ask_summarization=1"},{"index":9,"title":"Adipoz Dokunun Rolü","list":{"type":"unordered","items":["Nike hastalarında adipoz dokuda disfonksiyon oluşur.","Adipoz dokuda aşırı miktarda lipo-protein lipaz aktivasyonu, adiponectin hormonunun azalmasına neden olur.","Adiponectin azalması, patofizyolojik değişikliklerin ortaya çıkmasına sebep olur."]},"beginTime":1164,"endTime":1184,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1164&ask_summarization=1"},{"index":10,"title":"Adiponectin ve Karaciğer Hastalığı","list":{"type":"unordered","items":["Adiponectin azaldığında iskelet kasına giden yağ asidi oranı azalırken, karaciğere gelen yağ asidi miktarı artar.","Karaciğere fazla yağ asidi gelince statiz oluşur, bu da mitokondriyal oksidasyonu ve serbest oksijen radikallerinin fazla oluşmasını, inflamasyonu ve hepatit gelişimini artırır.","Hastalık ilk olarak statiz ile başlar, sonra inflamasyon ve hepatite geçer, bu evrelerden sonra fibroz gelişimi ve ilerleyen hastalıklara yol açabilir."]},"beginTime":1188,"endTime":1247,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1188&ask_summarization=1"},{"index":11,"title":"Adiponectin'in Özellikleri","list":{"type":"unordered","items":["Adiponectin, \"obezite karşıtı melek\" olarak tanımlanan bir yağ yakıcı moleküldür.","Adiponectin, kas hücrelerine yağ asitlerini yönlendirir, vücuttaki yağ miktarını azaltır, karaciğerde yağ girişini ve statiz oluşumunu engeller.","Adiponectin, trigliserit düzeyini azaltır, karaciğerde glikoz üretimini (glukoneozeni) azaltır, insülin sensivitesini arttırır ve metabolik sendrom karşı koruyucu etki gösterir."]},"beginTime":1247,"endTime":1320,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1247&ask_summarization=1"},{"index":12,"title":"NASH Hastalığının Gelişimi","list":{"type":"unordered","items":["NASH (non-alcoholic steatohepatitis) hastalığı statiz ile başlar ve sonrasında NASH (non-alcoholic steatohepatitis) evresine geçer.","NASH hastalarında hepatit, Zone 3'te görülürken, pediatrik olgularda Zone 1'de başlar ve bu durum biyopsi ile gösterilir.","NASH hastaları, viral hepatitlerde olduğu gibi kronik süreçten siroz ve kansere giden bir yol izlerken, NASH'ta direkt kansere dönüşüm olabilir."]},"beginTime":1320,"endTime":1414,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1320&ask_summarization=1"},{"index":13,"title":"NASH'in Histolojik Bulguları","list":{"type":"unordered","items":["NASH'in histolojik bulguları alkolik hepatit ile benzerdir: balonlaşma, Mallori cisimleri ve nötrofil infiltrasyonu görülür.","Farklı olarak NASH'ta nötrofillere oranla daha çok lenfo-plazmoster hücre infiltrasyonları görülür ve Mallori denklikleri daha azdır.","Özellikle pediatrik olgularda portal fibroz daha yoğun bir şekilde gözlenir."]},"beginTime":1414,"endTime":1504,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1414&ask_summarization=1"},{"index":14,"title":"NASH'in Klinik Özellikleri","list":{"type":"unordered","items":["NASH, metabolik sendrom, obezite, tip 2 diyabet, dislipidemi, hipertansiyon ve insülin direnci ile birlikte görülür.","Alete değerleri genellikle 150'nin altında hafif ya da orta düzeyde artar.","NASH, hepatit B ile eşlik ediyorsa progresyonu hızlandırır ve kriptojenik siroz hastalarının %90'ında NASH nedeniyle gelişir."]},"beginTime":1504,"endTime":1595,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1504&ask_summarization=1"},{"index":15,"title":"NASH'in Tedavisi","list":{"type":"unordered","items":["NASH, metabolik disfonksiyon ile ilişkili karaciğer hastalığı olarak tanımlanmaktadır.","Basit yağlanma durumunda, hasta egzersiz yapar ve yeme içme alışkanlıklarını değiştirirse geri dönüş mümkündür.","Siroz geçtikten sonra geri dönüş yoktur, hastaya ya karaciğer nakli yapmak gerekir ya da hasta komplikasyonlarla hayatını kaybedecektir."]},"beginTime":1595,"endTime":1779,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1595&ask_summarization=1"},{"index":16,"title":"Karaciğer Yağlanmasının Tespiti","list":{"type":"unordered","items":["Karaciğer yağlanmasının tespiti için ilk basamakta ultrasonografi kullanılır ve hastalarda ekojenite artışı görülebilir.","Biyopsi de yapılabilir ancak ilk basamakta kanıt olarak kullanılmaz.","Yağlı karaciğer hastalığını tanımlamak için hastanın alkol almaması veya belirli bir seviyenin üzerine çıkmaması gerekir."]},"beginTime":1787,"endTime":1861,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1787&ask_summarization=1"},{"index":17,"title":"Karaciğer Yağlanmasının Kriterleri","list":{"type":"unordered","items":["Hepatit virüsleri karaciğer yağlanmasında rol oynayabilir ve patolojik kriterlerde ekarte edilmelidir.","Karaciğer enzim yüksekliği kronik karaciğer hastalığının en sık sebebidir.","Erişkin popülasyonda üçte birinde yağlı karaciğer hastalığı bulunabilir."]},"beginTime":1861,"endTime":1939,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1861&ask_summarization=1"},{"index":18,"title":"Risk Faktörleri ve Patogenez","list":{"type":"unordered","items":["Obezite, tip 2 diyabet ve metabolik sendrom karaciğer yağlanmasının risk faktörleridir.","Metabolik sendrom, trigliserit yüksekliği, HDL düşükluğu, abdominal obezite, hipertansiyon ve glikoz yüksekliği ile ilişkilidir.","PNP-3 polimorfizmleri sadece nan-alkolik karaciğer hastalığında değil, alkolik karaciğer hastalığında da progresyonun daha hızlı olduğu gösterilmiştir."]},"beginTime":1939,"endTime":2101,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=1939&ask_summarization=1"},{"index":19,"title":"Patogenez ve Klinik Görünüm","list":{"type":"unordered","items":["Karaciğer yağlanmasının patogenezinde serbest yağ asitleri, insülin rezistansı ve trigliserit sentezi artışı önemli rol oynar.","Adipoz dokuda disfonksiyon ve adiponectin azalması insülin rezistansını artırır.","Karaciğer yağlanması genellikle semptomlarla tanınmaz, genellikle sirozla veya karaciğer enzim yüksekliği ile tespit edilir."]},"beginTime":2101,"endTime":2273,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=2101&ask_summarization=1"},{"index":20,"title":"Tedavi ve İlerleyiş","list":{"type":"unordered","items":["Karaciğer yağlanmasının tedavisinde hasta kendi kendini tedavi etmesi, kilo vermesi ve beslenme alışkanlıklarını değiştirmesi gerekiyor.","Tedavi edilmezse hastalar 10-15 yıl içerisinde yaklaşık %20'inde siroz gelişimi görülür.","Bu hastalığın en sık nedenleri ileri yaş ve tip 2 diyabet olup, kardiyovasküler hastalıklar en sık sonuç olarak görülür."]},"beginTime":2273,"endTime":2415,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=2273&ask_summarization=1"},{"index":21,"title":"Karaciğer Hastalıklarında AST ve ALT Değerleri","list":{"type":"unordered","items":["Karaciğer hastalıklarında genellikle AST değerleri daha yüksektir, ancak siroz hastalarında AST daha dominant yükselmeye başlar ve genellikle 250'nin altında kalır.","Alkolik karaciğer hastalığında da AST değerlerinin 400'lerin üzerine çok çıkması beklenmez, ancak AST daha dominant yükselir.","Akut karaciğer yetmezliği (ALF) geliştiğinde AST çok daha dominant yüksek olurken, siroz hastalarında AST'nin daha dominant yükseldiği görülür."]},"beginTime":2421,"endTime":2503,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=2421&ask_summarization=1"},{"index":22,"title":"Karaciğer Yağlanmasını Tanımlama","list":{"type":"unordered","items":["Karaciğer yağlanmasını tanımlamak için sadece AST/ALT değerleri yeterli değildir, ultrasonografi veya daha ileri görüntüleme yöntemleriyle yağlanmayı göstermek gerekir.","Karaciğer yağlanmasına neden olan önemli patolojileri ekarte etmek gerekir: erkeklerde haftada 21 bardak, kadınlarda 14 bardak alkol alımı.","Kadınlar alkolün etkisine daha duyarlıdır, bu nedenle aynı alkol miktarında daha hızlı alkolik karaciğer hasarı gelişir."]},"beginTime":2503,"endTime":2571,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=2503&ask_summarization=1"},{"index":23,"title":"Karaciğer Yağlanmasına Neden Olan Faktörler","list":{"type":"unordered","items":["Karaciğer yağlanmasına neden olan faktörler arasında hepatitler, ilaçlar (makrovezükler, tam oksidan, steroidler), metabolik sendrom ve yağlanma yatkınlığı yaratan ilaçlar bulunur.","Hemokromatozis, feritin yüksekliği ve otoimmün hepatit gibi hastalıklarda da karaciğer yağlanması görülebilir, ancak feritin yüksekliği proinflamatuar sitokinlerin varlığında normal karaciğer yağlanması hastalarında da görülebilir.","Feritin ve hemokromatozis ayırt edilemezken, HP mutasyonları analiz edilir veya karaciğer biyopsisi yapılabilir."]},"beginTime":2571,"endTime":2750,"href":"/video/preview/11404408625961508712?channelId=d3d3LnlvdXR1YmUuY29tO3VuZGVmaW5lZA%3D%3D&how=tm&parent-reqid=1754681110034861-6456979773409856647-balancer-l7leveler-kubr-yp-klg-318-BAL&text=Dr.+Atilla+Uslu+%28drdahiliye%29&t=2571&ask_summarization=1"},{"index":24,"title":"Karaciğer Biyopsisi İhtiyacı","list":{"type":"unordered","items":["Her zaman karaciğer biyopsisi yapılmasına gerek yoktur, hastanın klinik bulguları görüntüleme ile uyumluysa ekstra bir işlem gerekmez.","50 yaşından büyük, yıllardır metabolik sendromu olan hastalarda hepatit riski yüksektir, bu nedenle biyopsi yapılabilir.","Fibroscan gibi elastografide fibroz skoru yüksekse veya hemokromatozis veya otoimmün hepatit ekarte edilemezse biyopsi 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