Liver cirrhosis caused by schistosomiasis

Introduction Schistosomiasis liver disease Schistosomiasis japonca is a disease caused by Schistosoma japonicum parasitic in the portal system. Infected by skin contact with cercaria-containing plague water, the main lesion is granuloma caused by eggs in the liver and colon. In the acute phase, there is fever, hepatomegaly and tenderness, diarrhea or pus and blood, and the number of eosinophils in the blood increases significantly. The chronic phase is mainly caused by hepatosplenomegaly. In the late stage, it is mainly caused by fibrosis around the portal vein, which can develop into portal hypertension, spleen and ascites. Schistosomiasis was more prevalent in the early days of the founding of the People's Republic of China. Most of the areas have been initially controlled by the government's active efforts. However, in recent years, there are signs of re-ignition, and it is still necessary to be vigilant. Schistosomiasis cirrhosis is seen in the late stages of schistosomiasis and is caused by the massive deposition of eggs.

Cause

The cause of cirrhosis caused by schistosomiasis

The main pathological changes of schistosomiasis occur after the incubation period, that is, the larvae develop and grow, and begin to lay eggs. Due to the stimulation of mechanical and egg toxins, phlebitis, especially the colon, mesentery and liver, the lesions caused by eggs are required. It is more extensive and serious than that caused by adults. Therefore, it can be considered that "the pathological change of schistosomiasis is a lesion caused by eggs", and a complex pathological state is formed as a result of the interaction of the immune response of adults, eggs and the body. . Schistosoma japonicum inhabits the portal vein and mesenteric vein, and the number of eggs laid is also high. Therefore, intestinal and liver damage is more serious than that of Mann and Egyptian schistosomiasis.

an examination

Related inspection

Liver, gallbladder, pancreas, spleen MRI examination thyroid imaging liver dynamic blood pool imaging liver and gallbladder dynamic imaging liver disease ultrasound diagnosis

Examination of cirrhosis caused by schistosomiasis

1. Medical history: There is a history of epidemic areas and contact with infected water.

2. Pathogenic diagnosis: adopting fecal sedimentation hatching method, serum ring egg precipitation test, and immunological enzymes to detect specific IgM, IgG, IgE. In the past, the census was screened by intradermal test.

3. Immunological examination: used to assess the patient's humoral and cellular immune function.

4. Ultrasound: Chronic schistosomiasis has its characteristic ultrasound findings. It can be seen as a fibrous network image with a rectangular linear fiber structure. This phenomenon is rare in other liver diseases.

5. Sigmoid colonoscopy and rectal biopsy: The characteristic change of the yellow nodules can be seen. The positive rate in the acute phase is 50%--75%. In addition, there are different degrees of mucosal edema and congestion. In the chronic phase, there are plaque-like congestion and pale and shallow ulcers. Sometimes, there are multiple polyps and grape-like granuloma in the smallpox.

6. Liver biopsy: visible eosinophilic abscess, pseudonodular and fibrous hyperplasia in the portal area, you can find eggs.

7. The hepatic blood flow map reflects portal hypertension, which is different from hepatitis cirrhosis: the ratio of Zhang wave is higher. The main waveforms are low-level waves, which account for 55% and 45%, respectively. The latter can be intrahepatic portal vein branch occlusion, arteriovenous stenosis, and the liver blood supply is reduced to low waves. After surgery, the low-level wave is converted into high-slow wave and normal wave. Gaoshu Zhangbo also turned into a constant wave. In addition to the diastolic wave amplitude, the indicators of the hepatic blood flow map also showed significant changes. If the average amplitude increased, the diastolic index decreased, indicating that the liver blood circulation improved after splenectomy.

8.CT Chronic and advanced schistosomiasis may have intrahepatic calcification, especially in the right liver; leaves, with map-like or line-like changes. In the late stage, there is liver atrophy, hepatic fissure widening, liver margin is not smooth, uneven and nodular, left and right hepatic lobe imbalance, liver and spleen density changes, also visible splenomegaly and ascites, but the most characteristic There is a line of high-density shadows in the liver parenchyma with a number of line-like high-density shadows, which are arc-shaped, densely connected in a grid or ring shape, which is associated with pathological features of trunk cirrhosis, along the door The fibers of the branch branch hyperplasia are related to the dendritic distribution.

Differential diagnosis

Symptoms of cirrhosis caused by schistosomiasis

Alcoholic cirrhosis: Alcoholic cirrhosis occurs in association with alcohol consumption, gender, genetic factors, nutritional status, and whether it is associated with hepatitis virus infection. A large amount of drinking is more harmful than a small amount of drinking. Daily drinking is more harmful than intermittent drinking. Women who drink alcohol are more likely to develop alcoholic liver disease than men. Malnutrition, protein deficiency, combined with chronic hepatitis B or hepatitis C virus infection can increase the risk of cirrhosis.

Biliary cirrhosis: Biliary cirrhosis is a cirrhosis caused by biliary obstruction and cholestasis. It is rare and can be divided into secondary and primary. Primary people are even rarer.

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