Syphilis liver

Introduction Syphilis (syphilis) is a common sexually transmitted disease caused by infection with the human body by Treponema pallidum. It has been published for hundreds of years and is distributed all over the world. It is a very important sexually transmitted disease; it can be divided into acquired syphilis and congenital syphilis. And pregnancy syphilis and so on. The syphilis liver is liver damage caused by syphilis.

Cause

The causes of cirrhosis are many. In China, viral hepatitis is the most common. In North America and Western Europe, alcoholism is the most common. Pathophysiology of syphilitic cirrhosis: Syphilitic cirrhosis is an infectious, infectious disease caused by the specific pathogens Spirulina spirulina, Rickettsia, and Borrelia. Hepatic discomfort and hepatic pain are more specific. When such symptoms are first suspected to be caused by liver disease, traumatic factors should be excluded. Occasionally, normal people also have temporary liver pain and discomfort, which is relatively rare. Liver discomfort and pain in the liver area are often associated with hepatomegaly pressing the liver capsule. As the disease progresses, hepatomegaly is aggravated or reduced, and the nature and extent of pain in the liver area are also different. Liver cancer is generally progressive, mainly due to the continuous increase in liver cancer and the compression of the liver capsule.

an examination

Related inspection

Complement fixation test liver, gallbladder, spleen CT examination of liver, gallbladder, pancreas, spleen MRI examination liver dynamic blood pool imaging liver and gallbladder dynamic imaging

First, clinical manifestations

No pain, jaundice, bruises, bruises. Signs: chest / trunk vein dilatation; ascites sign; liver solid edge hard; chronic patient signs; liver anthurium, spider mites, edema.

Second, laboratory testing

1. Chemical test: serum aspartate aminotransferase increased, blood ammonia increased, serum albumin decreased, serum alanine aminotransferase increased, serum globulin increased.

2. Academic examination: syphilis serological test.

3. Examination: (1) ultrasound: splenomegaly; (2) X-ray/X-ray angiography: laparoscopic, liver calcification; (3) CT scan: spleen enlargement; hepatic portal system venous network, hepatic caudate lobe and liver right The leaf size ratio was 65, the right lobe of the liver was atrophied, the left caudate lobe was enlarged, and the liver was abnormal.

4. Pathological examination: Liver biopsy can be found: intrahepatic granuloma, diagnostic, hard liver edge. Contusion, bruises, thoracic veins, trunk vein dilatation, ascites, solid liver edge, hard, with chronic patient signs, liver anthurium, edema, spider mites and so on.

Third, complications: liver disease, renal amyloidosis, portal hypertension, systemic amyloidosis, esophageal varices, gastrointestinal amyloidosis, hypoalbuminemia, biliary hemorrhage, liver failure, hepatic encephalopathy, liver and kidney Syndrome, hepatic vein thrombosis, cirrhosis, jaundice, hepatic spleen amyloidosis, hyperglobulinemia, hepatitis (non-viral infection), etc.

Differential diagnosis

Discriminatory measures can identify syphilis cirrhosis by examination: elevated blood ammonia, decreased serum albumin, elevated serum alanine aminotransferase, elevated serum globulin, syphilis serological test, CT scan: spleen enlargement, X-ray : liver calcification, ultrasound: splenomegaly, liver CT: hepatic portal vein, X-ray examination: conventional abdominal plain film, spleen ultrasound, albumin measurement / blood, serum globulin syphilis serological test, spleen CT examination: spleen Increase, liver CT examination: hepatic portal system venous network, hepatic caudal lobe and right lobe size ratio 65, liver right lobe atrophy left caudal lobe enlargement, liver abnormalities. Identification with general cirrhosis: The clinical manifestations of cirrhosis are complex and need to be differentiated from diseases with similar manifestations.

(1) tuberculous peritonitis: cirrhosis ascites at the beginning, and when the progress is faster, there may be abdominal pain, palpation has tenderness, need to be identified with tuberculous peritonitis. The latter has symptoms of tuberculosis poisoning, abdominal can have a sense of flexibility, tenderness and rebound tenderness, symptoms and signs continue to retreat, the nature of ascites is exudate, and very few can be bloody ascites.

(2) Cancerous peritonitis: Carcinoma of the abdominal organs can be transferred to the peritoneum to produce ascites. When the age is over 40 years old, the onset is rapidly developing, the ascites can be bloody, and cancer cells can be found in the ascites.

(3) ovarian cancer: especially pseudo-mucinous cystic carcinoma, often with chronic ascites as a clinical manifestation, the disease progresses slowly, the ascites is leaking, sometimes causing difficulty in diagnosis, gynecological and laparoscopy are helpful for diagnosis.

(4) constrictive pericarditis: there may be a large amount of ascites, easy to be misdiagnosed as cirrhosis, but elevated venous pressure, jugular vein engorgement, obvious liver, obvious Qimai, strong heart sound, small pulse pressure can be identified .

(5) huge hydronephrosis and ovarian cysts: less common, no moving dullness, no liver disease, the former pyelography, the latter gynecological examination can help diagnose.

2. Upper gastrointestinal bleeding needs to be differentiated from peptic ulcer, hemorrhagic gastritis, gastric mucosal prolapse, and biliary bleeding:

(1) peptic ulcer bleeding: often has a history of ulcers, spleen is not large, no spleen hyperfunction. However, if it exists at the same time as cirrhosis, it is difficult to identify. Emergency endoscopy helps diagnose. Patients with cirrhosis accounted for 53% of patients with esophageal varices bleeding. The rest are ulcer disease or gastric mucosal lesions.

(2) hemorrhagic gastritis: may have incentives such as alcohol, drugs, etc., may have stomach pain. When it is combined with cirrhosis and gastric mucosal lesions, it is difficult to identify. A reliable diagnosis is emergency endoscopy.

(3) biliary bleeding: less common, often severe pain in the upper abdomen, fever, jaundice, gallbladder swelling and so on, hematemesis often occurs after severe abdominal pain. Gastroscopic examination, or retrograde cholangiopancreatography or percutaneous transhepatic cholangiography after hemostasis, can be found in the biliary system.

The above various hemorrhages can be selected for differential diagnosis by celiac angiography when necessary. The contrast agent escapes at the bleeding site and develops. The source of the bleeding can be inferred from the anatomy.

(4) Splenomegaly: It needs to be differentiated from diseases caused by other causes, such as malaria, leukemia, Hodgkin's disease, schistosomiasis and kala-azar. Malaria has a history of recurrent episodes, and malaria parasites can be found in the blood. The peripheral white blood cells of chronic myeloid leukemia can reach more than 10×109/L, and there are immature granulocytes in the classification. The bone marrow examination can confirm the diagnosis. Hodgkin's disease is often associated with lymphadenopathy, which can be diagnosed by lymph node biopsy. Black fever is rare in China. Occasionally, there are individual cases, irregular fever, epistaxis, bleeding gums, anemia and peripheral white blood cells are significantly reduced (3.0 × 109 / L or less), bone marrow examination or spleen puncture can be found. Schistosomiasis has a history of repeated exposure to water, schistosomiasis ring test, schistosomiasis complement test and skin test are positive. A serozoite egg can be found in a rectal mucosal biopsy. It can be used for fecal hatching test.

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