Symptom >> Internal Medicine >> Gastroenterology

Biliary Ascariasis

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Biliary tract ascariasis (biliary ascariasis) is the most serious complication of intestinal ascariasis. More common in 6-8 years old school-age children, farmers and late pregnant women. It is an acute upper abdominal pain or biliary tract infection that is caused by various causes of intestinal mites and is drilled into the biliary tract. The pain of the patient was unbearable at the time of the attack, and it was very painful to cry. If the treatment measures can't keep up, the advanced patients may have different degrees of dehydration and acidosis, and even life-threatening.

Cause

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.

Examine

an examination

First, clinical manifestations

Biliary tsutsugamushi is common in children and young adults, and women are more common. Most patients have a history of intestinal ascariasis, worms or worms. Some patients have had recent deworming treatment.

1. Abdominal pain: Abdominal pain is the main symptom of this disease. It is often located in the middle and upper abdomen under the xiphoid process. It is a paroxysmal drill-like severe cramps. The patient is tossing and turning, sitting and restless, sweating, and the patient often takes a bend and bends. Position, with the hand press the abdomen, the two hands are intended to tear the clothes, the endless. Generally, the pain lasts for a few minutes or more than 10 minutes, which is caused by the worm's withdrawal or the entire worm entering the bile duct or temporarily quiet and not twisting. Patients in the remission period after the onset of symptoms may be asymptomatic as normal or mild right upper quadrant pain. This kind of episode is very difficult to tolerate and the obvious difference between the intermittent period and the ordinary person is one of the characteristics of this disease. Abdominal cramps, often accompanied by nausea, vomiting, or retching, vomit is stomach contents and bile, about one-third of patients spit out aphids, the latter has special value for the diagnosis of this disease. In some cases, the entire worm enters the bile duct and is also painless.

2. No or only mild jaundice: another feature of the disease. Because the worm is sleek, it is not easy to completely block the biliary tract. If the secondary infection and inflammation caused by bile duct obstruction may be accompanied by significant jaundice, this is seen in 20% of cases.

3. chills, fever: more than 24 hours after the onset of biliary tract infection.

4. Abdominal signs: The disease is only slightly fixed tenderness under the xiphoid or right upper abdomen, no rebound pain and muscle health. Severe symptoms and mild signs are another feature of the disease. The skin sclera may have mild yellow staining. If the range of tenderness is enlarged, it is necessary to be alert to the possibility of complications.

Second, 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.

Diagnosis

Differential diagnosis

Differential diagnosis of biliary ascariasis:

If there are complications of biliary ascariasis, it should be differentiated from cholecystitis cholelithiasis, acute adenitis, acute perforation of gastroduodenal ulcer, intestinal ascariasis, urinary calculi, intestinal fistula, etc. As long as you carefully inquire about the characteristics of the "symptoms of inconsistency" in the early stages of biliary ascariasis and the occurrence of colics, if they are characterized by complications, they can be correctly diagnosed because they are covered by complications.