Intestinal roundworm infection

Introduction Ascariasis is the most common intestinal parasitic disease. The source of infection is tsutsugamushi patients and infected people. A large number of eggs are discharged with the patient's feces, contaminating vegetables and soil, and developing mature eggs under appropriate temperature and humidity for about 2 weeks. Mature eggs are passed through the mouth to the stomach, most of which are killed by gastric acid, and a few enter the small intestine to develop into larvae. The larvae penetrate the intestinal mucosa, enter the lungs through the lymphatic or microvascular entry veins, the liver and the inferior vena cava; and form a larva of about 1 mm after peeling in the lungs. The larvae pass through the microvessels and rise to the pharynx through the alveoli, bronchi, and trachea, and then swallowed into the stomach, which constitutes a hernia. When it reaches the small intestine, it develops into an adult. It takes about 75 days from the swallowing of eggs to adult maturation, and the survival time in the small intestine is about 1-2 years.

Cause

(1) Causes of the disease

The adult mites are parasitic in the middle and lower parts of the small intestine and occasionally enter the upper digestive tract. The locusts have a good hole. Therefore, the aphids entering the duodenum often drill into the biliary tract through the common bile duct opening. Clinical observations have noted that sometimes aphids can be spit out or crawled out through the mouth, patients with high fever, hunger, diarrhea or deworming with mountain roads and insufficient dose. Therefore, considering the change of the living environment of the locust may be the cause of the movement of the upper digestive tract.

(two) pathogenesis

There are more than one aphid drilled into the biliary tract, but there are also a dozen or even more than a hundred. Aphids rarely enter the gallbladder, and most of them stay in the bile duct system, including extrahepatic and intrahepatic bile ducts.

During the passage of the mites through the Oddi sphincter, the sphincter is paralyzed by stimulation, causing severe pain. After the mites exit the biliary tract or completely enter the biliary tract, the stimulation of the sphincter disappears and the severe pain caused by sputum is alleviated. Aphid activity in the biliary tract can also cause paroxysmal pain. It is also due to the activity of the mites that the passage of bile is not completely blocked, so jaundice is generally not present. Intestinal bacteria enter the biliary tract with the worm, which can cause biliary infection, causing acute inflammation of the gallbladder and bile duct, resulting in complications such as liver abscess, biliary bleeding, septic shock and sepsis.

We have seen cases of biliary peritonitis caused by the biliary tube being drilled by aphids, and cases of aphid-induced liver abscess breaking into the pericardium have been seen. In the case of original bile duct stenosis or stone, aphids entering the biliary tract often cause more serious complications. In addition, biliary mites can also cause acute pancreatitis and a series of complications. Some of the mites that enter the biliary tract can withdraw from the biliary tract. Those who did not withdraw, the activity gradually decreased, and finally died in the biliary tract. We have observed several cases of biliary ascariasis that occurred during the biliary T-tube drainage. The fragments of the corpus callosum in the biliary tract are discharged from the bile by the T tube and last for 1 to 2 months. During the same period, repeated cholangiography by T tube showed that the negative shadow of aphids in the biliary tract gradually became smaller, and some completely disappeared. This suggests the possibility of expelling the mites in the biliary tract.

On the other hand, the gallstone specimens taken out from the surgery can clearly see that the corpus callosum in the biliary tract is gradually embedded by the gallstone-like precipitate and finally forms various stages of the stone formation. Moreover, 40% to 84% of cases of bile duct stones can be found in the core of the gallstones to find mites or eggs. It can be seen that after the symptoms of abdominal pain of biliary ascariasis are alleviated, although some patients can shed the corpses in the biliary tract without leaving them. However, many patients are gradually attached and wrapped by gallstone-like sediments before their corpses have been released and drained, which in turn hinders their discharge and eventually forms stones. From this point of view, our treatment of biliary ascariasis cannot be aimed only at eliminating acute symptoms. It is also necessary to strive for the clean and thorough discharge of the biliary tract to prevent the formation of stones.

an examination

Related inspection

Gastrointestinal CT examination of gastrointestinal imaging duodenal juice and bile parasite examination

First, physical examination

Taking a medical history gives us a first impression and revelation, and also guides us to a concept of the nature of the disease.

Second, laboratory inspection

Laboratory examinations must be summarized and analyzed based on objective data learned from medical history and physical examination, from which several diagnostic possibilities may be proposed, and further consideration should be given to those examinations to confirm the diagnosis. For example, ultrasound examination shows that the bile duct is dilated, and there are linear swimming bodies inside. ERCP shows aphids in the biliary tract, or under the endoscope under the direct view of the duodenal papilla with aphid incarceration.

Differential diagnosis

The diagnosis is based on:

1. Paroxysmal cramps in the right upper abdomen or xiphoid, especially accompanied by "drilling pain", the remission period is as common as the person.

2. Abdominal pain accompanied by nausea and vomiting, a small number of patients have a history of spit or aphid.

3. Symptoms of severe signs are mild, only tenderness under the xiphoid and right ribs.

4. Ultrasound examination shows that the bile duct is dilated, and there are linear swimming bodies inside.

5. ERCP shows aphids in the biliary tract, or under the endoscope under the direct view of the duodenal papilla with aphid incarceration.

If there are complications, it should be differentiated from cholecystitis cholelithiasis, acute adenitis, acute perforation of gastroduodenal ulcer, intestinal ascariasis, urinary calculi, intestinal fistula, etc., as long as the identification of the above diseases, as long as careful Asked about the characteristics of the "symptoms of inconsistency" in the early stage of biliary ascariasis and the sudden and sudden occurrence of colic, and if it is characterized by complications, it can be diagnosed correctly because of the complications.

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