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الرئيسية » 🔬موسوعة التحاليل الطبية » Virusology » التهاب الكبد الوبائي Hepatitis

التهاب الكبد الوبائي Hepatitis

التهاب الكبد الوبائي
Hepatitis

نظرة عامة

ما هو التهاب الكبد الوبائي؟

هو التهاب فى الكبد غالباً ما يحدث بفعل عدوى فيروسية معينة. ومع ذلك قد ينشأ التهاب الكبد من التعرض للمواد الكيميائية ، أو من تناول أدوية تحت إشراف طبي أو من دون إشراف طبي ، أو تعاطي الكحول الزائد ، أو أمراض وراثية ، أو أمراض المناعة الذاتية ، أو تراكم الدهون في الكبد. قد يكون التهاب الكبد حاداً تزداد شدته ثم تخفت ويستمر ذلك عدة أسابيع إلى شهور ، أو قد يكون مزمناً تستمر مدته عدة سنوات. قد يستمر التهاب الكبد المزمن 20 سنة أو أكثر قبل أن يتسبب في ظهور أعراض التلف الكبدي تدريجياً ، مثل تليف الكبد وسرطان الكبد ، ويمكن أن يسبب الموت.

الكبد هو جهاز حيوي يقع في الجانب الأيمن العلوي من البطن. إنه يؤدي العدد من الوظائف في الجسم ، بما في ذلك تجهيز المواد الغذائية في الجسم ، وإنتاج الصفراء للمساعدة على هضم الدهون ، وتصنيع العديد من البروتينات الهامة ، وتنظيم تخثر الدم ، وكسر المواد التي يحتمل كونها سامة إلى أخرى غير ضارة يمكن للجسم استخدامها أو القضاء عليها. في الحالات الشديدة ، يمكن لالتهاب الكبد أن يوقف هذه العمليات مما يسمح للمواد السامة بالتزايد والنمو.

الأعراض المرضيّة و المُسبّبات

علامات وأعراض مرض التهاب الكبد هي نفسها (بغض النظر عن السبب) ولكنها قد تختلف من شخص لآخر وبمرور الوقت. معظم مرضى التهاب الكبد المزمن لا يمتلكون أية أعراض على الإطلاق. كذلك بعض مرضى التهاب الكبد الحاد لا يمتلكون أية أعراض ، لكن البعض منهم يمتلكون أعراض خفيفة و / أو غامضة قد يخلطون بينها وبين الأنفلونزا عن طريق الخطأ. من الأعراض والعلامات الشائعة ما يلي:

• الإرهاق.

• الغثيان.

• ألم في البطن.

• ألم المفاصل.

• حكة.

• إصفرار العينين والجلد (الصفراء هي العرض الوحيد الذي يؤكد الإصابة بتليف الكبد كسبب لأعراض أخرى).

بعض الأشخاص قد يعانون من أعراض وعلامات أخرى كنقص الشهية ، أو اللون الداكن للبول ، أو اللون الفاتح للبراز. قد تشمل المضاعفات الأكثر خطورة تراكم السوائل في البطن (مرض الإستسقاء) والإرتباك العقلي.

قد يكشف الفحص البدني للكبد عن تضخمه وإزدياده في الحجم. في بعض الأشخاص قد يضر التهاب الكبد المزمن الكبد بشكل تدريجي وبعد عدة سنوات قد يسبب الفشل الكبدي.

عادة ما يستمر النوع المزمن لسنوات عديدة ونادراً ما ينتهي دون علاج.

الفحوصات المعمليّة

تتواجد العديد من الفحوصات المعملية التي قد يتم إجرائها في حالة تأكيد الإصابة بمرض التهاب الكبد أو الشك به. قد تتم هذه الفحوصات في واحدة أو أكثر من الفئات التالية:

• إختبارات الفحص للكشف عن التهاب الكبد الفيروسي. على سبيل المثال ، يمكن إجراء فحص التعرض لالتهاب الكبد B أو التهاب الكبد C بسبب زيادة خطر المرض (إستخدام الأدوية غير المشروعة ، تعدد شركاء الجنس) أو أثناء التبرع بالدم.

• تحاليل للمساعدة في تشخيص الأسباب الكامنة وراء التهاب الكبد.

• تحاليل لمراقبة تضخم الكبد التالف و/أو المساعدة في تحديد العلاج.

قد لا يمتلك التهاب الكبد المزمن أية أعراض أو علامات واضحة وغالباً ما يتم تأكيده كنتيجة لتحاليل معملية روتينية غير عادية. هذا قد يشمل (على سبيل المثال) فحص شامل لعمليات الأيض كاملة (CMP) ، وهي مجموعة تحاليل غالباً ما يتم إجراؤها كجزء من الفحص الصحي السنوي ، أو فحص للكبد.

يشمل فحص الكبد وعمليات الأيض العديد من فحوصات الدم والتي قد تستخدم للمساعدة في تقييم حالة الكبد والكشف عن التهاب الكبد. وهي تشمل:

• تحليل الإنزيم الناقل للآلانين (ALT) – وهو إنزيم يتواجد بشكل رئيسي في الكبد. عند تلف الكبد ، يطلق ALT إلى الدم وعادة ما يحدث ذلك قبل ظهور أية علامات واضحة لتليف الكبد كالصفراء. مما يجعل هذا التحليل مفيداً للكشف عن تليف الكبد بشكل مبكر. غالباً ما تقارن النتائج مع نتائج إختبار AST للمساعدة في تحديد سبب إصابة الكبد.

• تحليل الإنزيم الناقل للأسباراتات (AST) – وهو أيضاً إنزيم يوجد بالكبد وقليل من الأعضاء الأخرى ، تحديداً القلب وعضلات أخرى. هذا الإختبار هو الأكثر فائدة في الكشف عن تلف الكبد بفعل التهاب الكبد ويمكن أن ترتفع نسبة الإنزيم (ALT) مع التعرض للأدوية السامة للكبد ، أو تليف الكبد ، أو إدمان الكحول. رغم ذلك فإن إنزيم (AST) ليس مختصاً بالكبد ويمكن أن تزداد نسبته في حالات تؤثر على أجزاء أخرى من الجسم. غالباً ما تقارن النتائج مع نتائج إنزيم (ALT).

• تحليل الإنزيم (ALP) – وهو إنزيم يرتبط بالقنوات المرارية ولكنه أيضاً يتواجد في أنسجة أخرى في الجسم. تحليل ALP غالباً ما يزداد عند انسداد القنوات المرارية لكنه قد يزداد أيضاً في حالة وجود إضطرابات العظام.

• تحليل البيليروبين – وهو مادة متكونة نتيجة تكسر كريات الدم والتي تصنع بشكل أساسي في الكبد والتي يمكن تدميرها من قبل الجسم. البيليروبين هو مركب الصفراء التي يمكن أن تتراكم عند تلف الكبد ، مما يسبب الصفراء والبول الداكن.

• تحليل الألبيومين – الألبيومين هو البروتين الرئيسي الذي يصنعه الكبد. ولأن الألبيومين يتم إنتاجه من قبل الكبد ، فإن مستواه يمكن أن يقل عند حدوث خلل في وظيفة الكبد. ومع ذلك ، يحدث هذا عادة فقط عندما يكون الكبد مصاباً بشدة. هناك العديد من الظروف الأخرى التي قد تؤثر أيضاً على مستوى الألبيومين.

• تحليل البروتين الكلي – الألبيومين والبروتينات الأخرى الموجودة بالدم ، قد تقل في حالة التهاب الكبد الحاد.

بالإعتماد على الطبيب و الفحوصات المعملية ، يوجد العديد من الفحوصات الأخرى التي قد يتم إجراؤها بشكل فردي أو كجزء من الفحص الشامل للكبد وتشمل:

إختبار قياس زمن البروثرومبين (PT) – يتم إجراء هذا التحليل لمرضى التهاب الكبد أو لمن يشتبه إصابته بالمرض. غالباً ما يتم تصنيع البروتينات المكونة للجلطة الدموية بالكبد ، في حالة طال زمن البروثرومين ، فإن ذلك قد يشير إلى شدة التليف الكبدي.

• تحليل (GGT) – وهو إنزيم يوجد بالكبد ويكون حساساً للتغيرات الحادثة في وظيفة الكبد. يساعد تحليل GGT على معرفة ما إذا كان سبب إرتفاع إنزيم (ALP) هو مرض في العظام أو الكبد ، في حال زادت نسبة إنزيم (GGT) مع إرتفاع نسبة ALP ، فإن المرض يكون في الكبد وليس في العظام.

• تحليل (LD) – وهو إنزيم يتم إطلاقه في حالة تلف الخلية ، وهو يتواجد في الخلايا المنتشرة في الجسم.

• تحليل (FP) – يتعلق بتجدد أو تكاثر الخلايا الكبدية.

في حين أن الفحوصات العامة المذكورة أعلاه قد تساعد في الكشف عن التهاب الكبد ، فإنها لا تحدد السبب الكامن وراء ذلك. قد يكون من الضروري إجراء فحوصات إضافية لتحديد السبب والمساعدة في العلاج المباشر. وهذه بعض الأمثلة:

• فحص التهاب الكبد الحاد الشامل – يمكن إستخدامه للمساعدة في الكشف عن العدوى بفيروس التهاب الكبد.

• فحص الأجسام المضادة (على سبيل المثال: ANA,ASMA,anti-LKM-1) المرتبطة بالتهاب الكبد المناعي الذاتي.

لأغراض التشخيص:

• يتم فحص نسيج الكبد : حيث يتم إدخال إبرة في الكبد لسحب كمية صغيرة من الأنسجة التي يتم فحصها تحت المجهر من قبل أخصائي علم الأمراض. وهي الطريقة الأكثر دقة لتشخيص تلف الكبد. ولأن هذا الإختبار حاسم ، فإنه يستخدم في المقام الأول عند إجراء اختبارات أخرى غير حاسمة أو لتحديد مدى تلف الكبد.

• يمكن إستخدام الفحوصات التصويرية ، مثل الموجات فوق الصوتية والأشعة السينية المتخصصة ، لفحص الكبد ، والكشف عن التهاب الكبد ، والمساعدة في التشخيص ، والمساعدة في تحديد سبب إصابة الكبد.


التهاب الكبد الفيروسي

تعتبر العدوى الفيروسية سبباً شائعاً من أسباب التهاب الكبد. يتم تسمية الفيروسات الخمسة المرتبطة أساساً بالتهاب الكبد وفق ترتيب إكتشافهم : A,B,C,D و E . في الولايات المتحدة ، التهاب الكبد الحاد عادة ما يكون بسبب فيروس التهاب الكبد A (أو HAV) ، فيروس التهاب الكبدB (أو HBV) ، وفيروس التهاب الكبد C (أو HCV). يسبب فقط فيروسي C و B التهاب الكبد المزمن.

التهاب الكبد A أو (HAV) يعتبر شديد العدوى وينتشر عن طريق الماء والغذاء الملوثين بفيروس التهاب الكبد A ، وقد إنخفضت معدلات الإصابة بفيروس A بشكل كبير منذ عام 1995 وذلك عندما تم إستعمال اللقاح. في عام 2014 ، تم الإبلاغ عن 1200 حالة حادة من التهاب الكبد A في جميع أنحاء البلاد وذلك طبقاً لمراكز السيطرة على الأمراض والوقاية منها (CDC). قد تكون الأرقام الفعلية أعلى ، وذلك لأن الأشخاص الذين ليس لديهم أعراض أو لديهم أعراض خفيفة فقط قد لا يدركون أنهم مصابون. وتشير التقديرات المصححة لمركز السيطرة على الأمراض إلى أن عدد الإصابات في عام 2014 ربما كان أقرب إلى 2500 حالة بسبب عدم الإبلاغ عن العدوى وعدم ظهور أية أعراض لها.

يسبب التهاب الكبد A عدوى حادة ولكن ليست مزمنة. عادة ما يشمل العلاج على العلاج الداعم فقط ، ومعظم الناس يتعافون تماماً في غضون ستة أشهر تقريباً. ينتج الجسم الأجسام المضادة للفيروس وذلك بعد وقت قليل من الإصابة ، لذلك فبعد التعافي من العدوى ، يصبح لدى الشخص مناعة مدى الحياة من المرض.

التهاب الكبد Bأو (HBV) يمكن أن ينتقل عن طريق الإتصال مع الدم ، السائل المنوي ، أو سوائل جسم الشخص مصاب. في أمريكا الشمالية وأوروبا ، ينتشر الفيروس في أغلب الأحيان عن طريق مشاركة الإبر أو المحاقن أو غيرها من المعدات المستخدمة في حقن المخدرات ، وعن طريق الإتصال الجنسي ؛ ومن الأم إلى الطفل أثناء الحمل (نادراً ما يحدث ذلك في الولايات المتحدة ، ولكنه موجود في أجزاء كثيرة من العالم).

تعتبر الإصابة بفيروس التهاب الكبد B هي السبب الأكثر شيوعاً لالتهاب الكبد الفيروسي الحاد في الولايات المتحدة ، ولكن أدى التطعيم إلى إنخفاض معدلات الإصابة تدريجياً. ووفقاً لمركز مكافحة الأمراض ، فإن هناك حوالي 19,200 حالة جديدة من العدوى بفيروس الالتهاب الكبدي الوبائي في الولايات المتحدة في عام 2014. العدد الرسمي لحالات التهاب الكبد B المسجلة هو أصغر بكثير وذلك لأن الكثير من الناس لا يعرفون أنهم مصابون ولا يهتمون بالعناية الطبية . ترتفع معدلات الإصابة بفيروس الالتهاب الكبدي الوبائي بين البالغين ، ولا سيما الرجال الذين تتراوح أعمارهم بين 25 – 44 سنة.

وتعتمد إحتمالية تطور عدوى فيروس التهاب الكبد الوبائي الحاد لعدوى مزمنة على العمر الذي يصاب فيه الشخص بالعدوى إلى حد كبير. فكلما كان الشخص المصاب بالعدوى أصغر سناً ، كلما زادت إحتمالية تطور حالته لعدوى مزمنة. حوالي 90٪ من الرضع الذين يكتسبون المرض تتطور لديهم العدوى لمزمنة. على العكس من ذلك ، فإن أقل من 5٪ من البالغين الذين يصابون بعدوى فيروس التهاب الكبد B تتطور إلى مزمنة.

عادة ما يشمل علاج عدوى فيروس التهاب الكبد الوبائي الحاد B على العلاج الداعم فقط ، ومعظم الناس يتعافون تماماً في غضون ستة أشهر تقريباً. ينتج الجسم الأجسام المضادة للفيروس وذلك بعد وقت قليل من الإصابة ، لذلك ، فبعد التعافي من العدوى ، يصبح لدى الشخص مناعة مدى الحياة من المرض.

لا يعاني الأشخاص المصابون بالتهاب الكبد B عادة من أية أعراض للمرض وذلك لعقود طويلة ، قد يساعد العلاج بالأدوية على إبطاء تقدم أو تطور تلف الكبد الناجم عن العدوى المزمنة. وفي حالات الفشل الكبدي ، قد يتم إجراء زراعة للكبد.

التهاب الكبد C أ (HCV) ينتشر عن طريق التعرض للدم الملوث. إن أكثر الطرق شيوعاً للإصابة بالتهاب الكبدي الوبائي C هي تقاسم الإبر المستخدمة في تعاطي المخدرات عن طريق الحقن مثل الكوكايين أو الهيروين. كما يوجد عدة وسائل أخرى تنتقل من خلالها العدوى ، حيث ترتفع إحتمالية الإصابة لدى العاملين في مجال الصحة وذلك عن طريق الإبر المستخدمة أو غيرها من الأشياء الحادة. تنتقل العدوى أيضاً من خلال النشاط الجنسي الذي يؤدي إلى تمزق الأنسجة ، كما تنتقل من الأم إلى الطفل أثناء الولادة ، ومن خلال تقاسم المواد الشخصية الملوثة بالدم ، مثل شفرات الحلاقة وفرشاة الأسنان.

في عام 2014 ، كان هناك حوالي 30.500 حالة التهاب الكبد الحاد C في الولايات المتحدة. عادة لا يتم الإبلاغ عن العديد من الحالات ، كما أن كثير من الناس لا يعرفون أصلاً أن لديهم عدوى لأنهم ببساطة لا يملكون أية أعراض. تتطور العدوى وتصبح مزمنة لدى حوالي 75-85 ٪ من بين المصابين بالتهاب الكبد C .ووفقاً لتقارير مراكز التحكم بالأمراض ، فإن هناك ما يقدر ب 3,5 مليون شخص في الولايات المتحدة يعانون من التهاب الكبد المزمن C. يتطور التهاب الكبد المزمن C لمرض الكبد المزمن

وذلك لدى حوالي 60-70 ٪ من المصابين بالتهاب الكبد المزمن C والذين لم يتم علاجهم ، كذلك فإن ما يقرب من 5-20 ٪ سوف يتطور لديهم المرض لتليف الكبد وذلك على مدى سنوات عديدة ، وحوالي 1-5 ٪ يموتون جراء العدوى المزمنة ، مثل تليف الكبد أو سرطان الكبد.

لا يوجد لقاح متاح للوقاية من التهاب الكبد C ، ولكن الأبحاث مازالت تجرى لتطوير واحد. وفي الوقت الحالي ، فإن أفضل طريقة لتجنب الإصابة بالعدوى هي الحد من التعرض للمصادر المحتملة للفيروس ، ولا سيما تقاسم الإبر لحقن المخدرات. يمكن علاج كل من التهاب الكبد C الحاد والمزمن عادة باستخدام مجموعة من الأدوية.

التهاب الكبد الوبائي (D) و (E) من الحالات نادرة الحدوث في الولايات المتحدة. يكون التهاب الكبد D عادة مصاحباً للالتهاب الكبد B ، ويمكن أن يجعل العدوى أكثر حدة ، وهوعادة ما ينتشر عن طريق التعرض للدم المصاب أو الإبر. أما التهاب الكبد E فإنه ينتشر بطريقة مماثلة لالتهاب الكبد A وينتشر في آسيا والشرق الأوسط وأفريقيا وأمريكا الوسطى والجنوبية ، إضافة لوجود أعداد متزايدة من الحالات التي يتم اكتشافها في الولايات المتحدة على الرغم من أن أصحابها لم يسافروا إلى هذه المناطق. التهاب الكبد E نادراً ما يسبب التهاب الكبد المزمن وذلك في الأشخاص الذين لا يعمل جهازهم المناعي بشكل جيد.

علامات وأعراض التهاب الكبد الفيروسي تتوافق غالباً مع تلك الخاصة بالتهاب الكبد بشكل عام.

الفحوصات المعملية

يوجد العديد من إختبارات الدم التي تُجرى للمساعدة في تشخيص و رصد التهاب الكبد الفيروسي التي تسببها مجموعة معينة من الفيروسات.

الوقاية

لقد إنخفض معدل الإصابة بالتهاب الكبد الفيروسي وذلك بسبب الطرق الآمنة في إستخدام الحقن والممارسات الجنسية (وهي مهمة في الوقاية من التهاب الكبد B و C) وتوافر اللقاحات الخاصة بالتهاب الكبد الفيروسي A و B (مازال لا يوجد حتى اللحظة أي لقاح متاح لالتهاب الكبد C). ساهم فحص وحدات الدم في القضاء عملياً على العدوى من خلال عمليات نقل الدم ، وقد أدى البرنامج المتبع لفحص الأمهات الحوامل لالتهاب الكبد Bوتطعيم جميع المواليد الجدد إلى إنخفاض كبير في حالات الإصابة بالتهاب الكبد B.

العلاج

التهاب الكبد A

إن تقديم الدعم والتخفيف من الأعراض غالباً ما تكون العلاجات الوحيدة المطلوبة لالتهاب الكبد الحاد A ، وهذا عادة ما يشمل الكثير من الراحة وتناول السوائل ، إضافة للتغذية الجيدة. عادة ما يتعافى معظم الناس من التهاب الكبد A دون حدوث أي مضاعفات.

التهاب الكبد B

عادة ما يعتمد علاج التهاب الكبد B في المقام الأول على الراحة وتناول الكثير من السوائل والتغذية الجيدة . بالنسبة لأولئك الذين يتحول لديهم المرض إلى شكل مزمن من التهاب الكبد B ، فإن أهداف العلاج تشمل التقليل من الضرر الذي يصيب الكبد ، ومعالجة الظروف التي تسبب تفاقم الحالة ، ومنع انتقال الفيروس. هناك أدوية متاحة لعلاج التهاب الكبد المزمن B ، ولكن ليس كل الناس بحاجة إلى علاج. يتم مراقبة الأشخاص المصابين بالتهاب الكبد المزمن عن كثب وذلك لاحتمالية حدوث تليف كبدي أو سرطان.

التهاب الكبد C

يتطور التهاب الكبد الحاد إلى مزمن وذلك لدى حوالي 75-85 ٪ من الأشخاص الذين يعانون من التهاب الكبد الحاد C ويمكن علاج كلا الحالتين عادة باستخدام مجموعة من الأدوية. على الرغم من أن بعض الناس يتعافون تلقائياً من التهاب الكبد الحاد C وذلك دون الحاجة لأي علاج ، إلا أن العلاج يقلل من خطر تحول العدوى لمزمنة. وتستخدم نفس الأدوية المستخدمة لعلاج التهاب الكبد المزمن C لعلاج شكله الحاد ، ولكن لا يزال من غير المؤكد معرفة أفضل علاج لالتهاب الكبد الحاد C ومتى قد يبدأ استخدامه.

يختلف الأسلوب المتبع في علاج التهاب الكبد C المزمن وذلك على أساس التركيب الجيني (النمط الوراثي) لفيروس C المسبب لالتهاب الكبد ، وأيضاً ما إذا كان الشخص قد عولج سابقا من عدوى فيروس التهاب الكبد الوبائي ، صحة كبد الشخص ، إضافة لعوامل أخرى.

يمكن الإطلاع على قائمة الأدوية المعتمدة والتي تستخدم لعلاج التهاب الكبد الوبائي C من خلال زيارة الموقع الإلكتروني لإدارة الغذاء والدواء الأمريكية.

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  15. 3 ساعات
    VincentEpilm

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    Custom made bobble heads are quick getting to be a very hot commodity, Particularly as holiday getaway approaches and folks stay up for benefit from the festivities that happen to be to come back. Bobblehead customized dolls can be a fantastic advertising merchandise for your following event. Nevertheless, many firms might not notice how uncomplicated it truly is to tailor made style bobblehead dolls with your company symbol or Get in touch with facts.

    Non-personalized bobblehead orders frequently ship in just 48 hours after an get is put. Should the cake topper is by now pre-made, some manufacturers will apply the colour and layout to your pre-made cupcake or cake. The only real exception are orders put on the weekends or holiday seasons for the reason that most companies are shut until the holidays. In such cases, you may need to deliver your individual coloured cake topper.

    A good way to find custom bobbleheads is to search on the web auction sites. Over and over businesses will offer their present inventory on an auction Internet site in hopes of rapidly going inventory. You may be able to get a customized bobblehead doll at a less expensive rate than what you would purchase from a regular retail outlet. Ensure the business you are obtaining from has a superb popularity which is a member of the Better Enterprise Bureau. There’s nothing worse than purchasing a cake topper and discovering out it is defected and faulty.

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  16. 3 ساعات
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  17. 3 ساعات
    Thomasdah

    Nowadays coloured contacts have grown to be quite common in present day societies for their fast and drastic adjust of seems to be. Whether or not for practicality, Halloween costumes or just for trend, people have been obtaining much more fascination in these thrilling professional medical products. Folks can now alter the colour in their eyes with colored contacts that don’t involve surgical procedure. These coloured eye equipment can be bought from any regional retailer. The top coloured contacts on the other hand are those that match the normal colour of your respective eyes beautifully.

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  18. 3 ساعات
    Michaeldor

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    How much will it cost to ship a toupee for guys? Shipping toupees is frequently carried out by freight forwarders who focus on custom and international shipments of hair replacement prosthesis. How do they Invoice you for the delivery of one’s toupee? Simply put, you shell out the freight business.

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    Can toupees for men for use to replace my organic hair? Certainly, toupee hair methods for men may be used to exchange the hair in your scalp. A toupee is usually a hair method that is certainly attached to the very best within your head with straps. The straps are then fastened to your scalp so that the toupee could be securely held in place until finally you are ready to fashion your hair.

    Are toupees suitable for me? toupees for guys are an incredible solution for any person who would like to try to address up their baldness. If the baldness is just not leading to you shame on the place of work or in public, toupees could possibly be a really perfect option for you. Just because toupees are worn on The top, would not indicate they can’t be accustomed to cover other areas of your body in addition. With so a number of options for covering your baldness, toupees have become fairly well known.

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