Echinococcosis Of The Liver - Causes, Symptoms And Treatment

2023 Author: Riley Dean | [email protected]. Last modified: 2023-11-27 09:15

How does the liver become infected with echinococcus, treatment of pathology

Content

1 What is liver echinococcosis, how does infection occur
2 Echinococcus of the liver, symptoms
3 Varieties of liver echinococcus
4 How is hepatic echinococcosis diagnosed?
5 Complications
6 How to treat liver echinococcus
- 6.1 Preoperative preparation
- 6.2 Operation to remove the echinococcal cyst of the liver
- 6.3 Complications after surgery
7 Prevention

Penetration of the larvae of the parasite Echinococcus granulosus into human liver cells provokes the formation of parasitic tumor-like formations. The tapeworm larva also parasitizes in herbivorous mammals. Infected food and water can cause the larvae to enter the body. Eggs, passing through the gastrointestinal tract with food, turn into oncospheres. Then they are carried by the blood throughout the body and are concentrated in the liver. Only there the further development of the larva itself takes place. For 5-6 months, a fibrous capsule is formed from the larva. If the capsule bursts, such fibrocapsules appear and grow next to it.

What is liver echinococcosis, how does the infection occur

What is liver echinococcosis

There are a number of ways to get infected with this parasite. Before entering the human body, the tapeworm goes through a number of stages in its evolution. And his last "home" is a dog and very rarely a cat. It parasitizes in the intestines of the animal in the form of mature individuals. A person can become infected by contact with a dog.

Eggs of worms, along with feces, enter water bodies, remain on the soil, and are spread by rodents everywhere. Rodents are often hunted by wild animals, which subsequently also become infected with parasites. That is why poorly processed bushmeat can cause echinococcosis in the liver of hunters.

The eggs of this parasite also with food, water enter the digestive system of farm animals. This is why meat should be boiled or roasted well. The larvae enter the human body through the stomach, in the intestine they pass with the blood to the liver, forming colonies in the form of neoplasms.

Echinococcus of the liver, symptoms

The clinical picture of liver echinococcosis in the early stages is not noticeable. Many years can pass from the moment of infection, while the infected person will not feel any suspicious symptoms. If the cysts are located in the center of the liver and are small in size, they are difficult to identify by palpation. The infected does not observe any symptoms.

With lesions, patients note:

Painful sensations of a dull nature in the right side of the abdominal cavity, radiating to the right shoulder blade, lower back, back, lower region of the right side of the chest;
With large hydatids, a protrusion is found in the area under the right ribs;
There is an enlarged outline of the liver in the upper zone (hepatomegaly);
On palpation, a rounded, elastic-elastic or more solid formation is felt, more often in the antero-inferior region of the liver.

These are characteristic symptoms of parasite infestation. Among the intermittent symptoms, patients observe shortness of breath, heart palpitations, weakness, and impaired appetite. Against this background, dyspeptic symptoms appear. Patients complain of nausea, vomiting, disturbing heartburn.

Even mild, intermittent symptoms in people living in problem areas, where this disease is noted quite often, is a signal for alertness and attentiveness to health.

The main and most objective sign is the detection of swelling in the right hypochondrium. When tapped, a dull sound is felt, echoing into the liver itself. This sound occurs when the neoplasms tremble.

If the hydatid cyst is located in the area of the diaphragm, it cannot be palpated, but its presence is indicated by the increased size of the liver from below and its protrusion forward from the hypochondrium.

With the posterior diaphragmatic location of the hydatid cyst, compression of the portal and inferior vena cava is noted, the symptoms are as follows: expansion of the veins of the abdomen, saphenous veins on the chest, swelling of the extremities.

In 6 - 9 patients out of 100, the disease is accompanied by jaundice. Its intensity depends on the strength of the hydatid pressure on the bile ducts. This can provoke biliary cirrhosis and even blockage of the bile ducts by parasite particles when the neoplasm ruptures.

Very rarely, but there is a case when parasite infestation is accompanied by urticaria. This symptom indicates a rupture of an echinococcal cyst or the appearance of cracks on it and the outpouring of all contents into the abdominal cavity or pleural cavity.

When infected with Echinococcus granulosus, blood counts change. There is an increase in the number of eosinophils, according to statistics in 18-63% of cases. If the number of eosinophils is more than 4%, this is already a signal about the possible presence of echinococcosis in the body. In the presence of parasites, the percentage of eosinophils can reach high numbers, 70 or more. But eosinophilia can manifest itself after taking antibiotics or with other diseases.

The most dangerous is the suppuration of hydatids and the penetration of its fluid into the abdominal cavity. Anaphylactic shock occurs and peritonitis develops.

If a crack has formed in the hydatid, suppuration develops, this process causes severe pain, leads to a severe form of purulent intoxication.

Varieties of liver echinococcus

According to the structure of neoplasms, echinococcosis is divided into two types:

Alveolar (multi-chamber), affects most of the liver, an increase in the spleen and the appearance of jaundice is noted in half of the patients, with a neglected state, liver samples deteriorate;
Bubble (single-chamber), looks like a bladder covered with a multilayer membrane, echinococcal capsules are concentrated in it, localized in most cases in the right lobe of the liver.

According to the location, echinococcosis is of three types:

Anterior, diagnosed by palpation;
Lower, the zone of location closer to the abdominal cavity, the structure of the cyst is elastic;
Ascending, the liver on x-ray examination has the shape of a dome, symptoms like exudative pleurisy.

The disease is most common in the countries of Central Asia, Kazakhstan, identified in Georgia, on the Crimean peninsula, in Siberia.

How is liver echinococcosis diagnosed?

In a blood test in people living in endemic regions and suspected of having liver echinococcosis, more than 20% of eosinophils are found. To diagnose hydatids, tests are made using the Katzoni reagent, similar to a test for tuberculin. In people with a hydatid cyst, the Katzoni test is positive (in 80 percent of patients). And only a year later, this reaction becomes negative.

X-ray examination shows a highly domed diaphragm, and calcifications in the neoplasms are noted.

Clarified information about the location of the hydatid, its forms are obtained by radioisotope hepatoscanning. Ultrasonic echolocation is also performed, computed tomography is prescribed.

Also used invasive diagnostic methods: laparoscopy and angiography. More precisely, arcuate displacement of the liver vessels is determined using celiacography.

Complications

Rupture of a hydatidous neoplasm is dangerous with negative consequences, purulent processes may develop, the clinical picture becomes more complicated. The patient suffers from fever, continuous pain in the region of the liver. In the blood, an abnormally high number of neurophils that cause neutrophilic leukocytosis, an acceleration of ESR is noted, indicating the presence of an inflammatory process. There are no eosinophils in the blood - evidence of an acute infection. The protective cells of neutrophils change, acquiring a granular shape.

With the outpouring of the contents of the cyst into the circulatory system and bile ducts, the patient is worried about severe itching, urticaria pours out, and can reach anaphylactic shock. The likelihood of developing peritonitis is high. If an infection enters the respiratory tract, secondary echinococcosis may develop in the lungs.

How to treat liver echinococcus

All experts came to the same conclusion: it is impossible to achieve complete recovery using exclusively therapeutic methods with the help of drugs, the treatment of liver echinococcosis is carried out only by a surgical method. To date, not a single effective drug has been developed to combat this parasite. Since there is a high risk of cyst rupture and suppuration, it is impossible to delay the operation. Removal of the hydatid cyst is carried out by the method of echinococcectomy.

Preoperative preparation

Any operation, and even more so complex as the removal of a hydatid cyst, requires preparation of the body. The liver has a high degree of compensation, its functionality can be fully preserved even in cases where half of the parenchyma is not functioning.

Before the operation, appoint:

A low-calorie diet that includes highly digestible proteins;
Bed rest;
Administration of glucose with insulin, vitamins, injections with ascorbic acid.

With anemia, strictly bed rest is recommended and the calorie content of the diet is increased to 5000 calories by adding carbohydrates. In the presence of jaundice, the patient is prescribed a blood and plasma transfusion and drip infusion of isotonic solutions. If found, suppuration is added with antibiotic treatment.

Surgery to remove the echinococcal cyst of the liver

Treatment of echinococcus of the liver by surgical removal of a hydatid cyst is a complex operation, when it is performed, there is a high risk of the parasite larvae getting into adjacent tissues. Therefore, the operation is carried out only by experienced specialists who are familiar with the techniques of minimally invasive interventions using modern high-tech devices. The purpose of the operation is to remove the neoplasm together with the entire membrane. The neoplasm is excised and endoscopic drainage is performed at the location of the hydatida in the liver. Hermecides, chemicals that destroy parasites, are injected into the resulting cavity to prevent relapse.

When choosing a technique for the operation, the size of the formation and the location of localization are taken into account. With an ideal echinococcectomy, the hydatid is completely excised, but this method is rarely used, only with the marginal location of the cyst and its small size. If large neoplasms are removed in this way, there is a high risk of touching large vessels and bile ducts. Large neoplasms are excised after the puncture of the hydatid cavity, when all the contents have been removed. This technique allows you to remove neoplasms without the risk of rupture. After removal, the cavity is treated with formalin 2% solution, capitonage (suturing) is performed. If the size of the formation was too large, the walls of the cavity are sutured to the anterior abdominal wall.

In cases of single and giant cysts, anatomical liver resection is performed (part of the organ is excised).

In order to prevent seeding with worm heads, the cavity is treated with antiparasitic drugs, cryo-treatment is performed, or a CO2 laser is used.

If the bladder ruptures, an urgent operation is performed, followed by drainage. With multiple neoplasms in the liver, operations are performed in several stages with an interval of 2 weeks to 3 months. Lethal outcomes with such operations are 1 - 5%, relapses are possible, they are about 2-25%, relapses are possible with unnoticed cysts and seeding of the cavity.

Complications after surgery

In the first place among the complications arising during the operation, are bleeding. They are caused by damage to the parenchyma of the liver or a large vessel. The most dangerous bleeding is with injured hepatic veins and arteries.

They also appear after 2 - 3 days of bile leakage into the abdominal cavity, although during the operation this process was not observed, it threatens with peritonitis and ends most often sadly, with a lethal outcome.

If the patient loses a lot of bile, it is replenished through a tube directly into the stomach.

Among the complications, there is a subphrenic abscess, as well as suppuration in the sutured area. The patient's temperature rises sharply to 39 degrees, pain is noted. X-rays show the presence of fluid with bubbles. The abscess drains according to all the rules.

The results of echinococcectomy depend on a number of factors: the size and location of the neoplasm, the stage of the disease, the skill of specialists. Lethality is observed in complicated forms. At present, postoperative mortality has been practically reduced to zero.

Prevention

Prevention of infection

All preventive actions are aimed at destroying the source of the invasion so that a person cannot pick up the parasite. For this purpose, instructions and recommendations for veterinary medical institutions have been developed for registering dogs, conducting deworming in them, as well as for the destruction of stray animals. Deworming of dogs in winter is carried out every month and a half, in warm weather - once a month. This must be done in special areas, animal feces are collected and disinfected, the ground is sprayed with chlorine solution.

In order to prevent dogs from becoming infected with parasites, it is necessary to prevent them from entering meat processing plants, places of slaughter and burial of animals. Categories of people engaged in hunting, raising fur-bearing animals, who often come into contact with animals, should be periodically examined for infection with echinococcus.

Personal precautions include special hygiene after contact with dogs, walks, gardening, picking mushrooms. It is necessary to wash your hands thoroughly, do not eat unwashed foods, fruits, berries, vegetables. It is necessary to be especially careful with water. Do not drink water from reservoirs without prior long boiling.

If there are characteristic symptoms of infection with an echinococcus of the liver, you should contact a hepatologist, infectious disease specialist or gastroenterologist.