Hepatic hydatid disease
Introduction
Introduction to liver echinococcosis The disease is a common parasitic disease in pastoral areas. The vast majority of the dogs are infected with canine eggs by the dog, and they hatch into the hydatid cysts through the portal vein to the liver after hatching into the six hooks in the stomach and duodenum. A few are echinococcosis caused by aphids of Echinococcus granulosus. Hepatic hydatid invaded the right lobe, and the left lobe and left and right lobe were less. There are two types of clinical: 1 single echinococcosis (hydose cyst or cystic echinococcosis), which is a capsule with a capsule that grows slowly, and the inner wall of the capsule (the germinal layer) grows into the cavity. The inner wall of the ascus grows out of the head section. 2 vesicular echinococcosis. A grayish-white hard vesicle is formed in the liver, which does not contain a cystic fluid and contains a bean-like substance. basic knowledge The proportion of illness: 0.0025% Susceptible people: no specific population Mode of infection: digestive tract spread Complications: nausea and vomiting, abdominal distension, jaundice, ascites, urticaria, cough, abdominal pain
Cause
Causes of liver echinococcosis
Cause of disease
The main terminal host of canine aphids is dogs. The intermediate hosts are mainly sheep, cattle and horses, and humans can also serve as intermediate hosts. Canine worms are parasitic in the small intestine of dogs. Eggs are excreted in the feces and often adhere to the hair of dogs and sheep. When a person eats drinking water or food contaminated with eggs, he is infected. The eggs of the swallowed poultry are in the duodenum of the intestines, and through the action of the digestive juice, they are taken out of the intestinal mucosa and enter.
Pathophysiology
The hydatid sputum entering the liver first develops into a small empty sac, which is the initial hydatid cyst, which does not contain the cephalic ganglion; as the sac is gradually enlarged, a hydatid cyst is formed, that is, the inner sac. The inner capsule can be divided into two layers, inner and outer, and the outer layer is a multi-layered cortex, which has elasticity, such as powdery skin, which is white and translucent; the inner layer is a germinal layer, which is very thin, and is actually the body of the hydatid. Can produce a lot of head sections and hair follicles. After the hair follicles fall off, the same as the mother capsule is formed; the ascus can produce a sun sac. Most of the head section adheres to the wall of the capsule or deposits on the bottom of the capsule to form "hatchworm sand". During the growth of the hydatid cyst, due to the defense reaction of the human tissue, a fibrous envelope is formed around it, called the outer capsule; its thickness is about 3-5 mm, and calcification can occur. The hydatid cysts are mostly single-shot, and about 1/4 are multiple. The cyst grows slowly, the small one is like a grape, and the larger one has a volume of up to 20,000 ml. The hydatid cyst is transparent, weakly alkaline, contains a large number of nodules and ascus, and a small amount of inorganic salts and proteins. A small amount of cystic fluid permeates outside the wall of the capsule and is sensitized for absorption by the human body. For example, the cyst breaks through the human body cavity, and a large amount of fluid is absorbed, which may cause an allergic reaction or shock, and even cause death. In the sac, the germinal layer, ascus and cephalic ganglion may be destroyed by nutrient deficiency, and may also be broken due to the wall of the capsule. After the infiltration of the bile fluid or the infection, the vitality is lost, and the cystic fluid and the germinal layer become yellow rubber. Body, even calcification. Cysts can also be followed by bacterial infections.
Prevention
Hepatic hydatid disease prevention
1. Prevent the widespread promotion of knowledge about echinococcosis in livestock areas;
2, eliminate wild dogs, strengthen the management of domestic dogs, children do not play dogs;
3, to prevent dog feces pollution grassland, feed, water source, prevent disease in the sheep, strengthen slaughter management, the dead sheep body should be buried or burned;
4. Pay attention to personal hygiene;
5. Protect water sources and do a good job in environmental sanitation.
Complication
Hepatic hydatid complications Complications, nausea and vomiting, abdominal distension, jaundice, ascites, urticaria, cough, abdominal pain
When developing to a certain stage, there may be a feeling of fullness of the upper abdomen, slight pain or compression of the corresponding symptoms caused by adjacent organs. If the mass is pressed against the gastrointestinal tract, there may be upper abdominal discomfort, loss of appetite, nausea, vomiting and bloating. The cyst located at the top of the liver can raise the diaphragm upwards, compressing the lungs and affecting the breathing. The cysts located in the lower part of the liver can compress the biliary tract, causing obstructive jaundice, and the portal vein can produce ascites. More commonly, the patient suffers from various complications. Visiting, such as skin itching due to allergic reactions, urticaria, difficulty breathing, cough, purpura, vomiting, abdominal pain, cystic secondary infection is a very common symptom.
Symptom
Hepatic echinococcosis symptoms Common symptoms Loss of appetite, weight loss, jaundice, abdominal mass, upper abdomen, abdominal pain, ascites, bloating, itching, nausea
1 cystic echinococcosis, with a history of pastoral life or a history of close contact with dogs, early asymptomatic, and then slowly growing in the right upper abdomen, a feeling of fullness, liver discomfort, pain, liver enlargement, touch The capsule is sexy. When the cyst compresses the common bile duct, there may be jaundice. If the portal vein or the vena cava is pressed, ascites may occur, the lower extremity may be swollen, and the gastrointestinal tract may show symptoms such as indigestion. The cyst breaks into the abdominal cavity and produces severe abdominal pain and allergies. Shock, when you have bronchospasm, take a powdery skin sample,
2 vesicular echinococcosis, rapid growth, liver area may have tingling, pain, and even severe pain, the liver is obviously swollen, the liver area touches a hard mass, the surface is uneven, and the late stage is often accompanied by weight loss, jaundice, ascites , fever, etc.
Examine
Hepatic hydatid disease examination
First, immunological diagnosis
(1) Common methods: intradermal test (ID), which is simple and sensitive to diagnosis, but due to the operation method, the positive standard and antigen injection amount have not been standardized, and the false positive reaction is the shortcoming. Indirect hemagglutination test (IHA) ), the positive rate is about 91%, the false positive rate is 3.8%, the reaction is sensitive and the false positive rate is low, which has the advantages of quickness and simplicity. The latex agglutination test (LAT) is easy to operate, and the sensitivity and specificity are also high. The sensitivity of agargeldiffusion (AGD) and arc 5 double diffusion (DDS) are 41%-97% and 82.1%, respectively. The two methods are simple to operate, the reaction is rapid, the reagent amount is small, and convective immunoelectrophoresis (counter immunoelectrophoresis; CIEP), immunoelectrodiffusion (IED), enzyme-linked immunoelectrophoresis (ELIEP) and enzyme-labeled antigen-linked immunoelectrophoresis (ELA-CIEP) are sensitive and specific. Diagnostic method, Pinon (1976) can detect whether the cyst is ruptured according to the special glove finger shape of the CIEP precipitation zone. CIEP is negative from 3 to 7 months after surgery, indirect immunofluorescent antibody test (IFA). The defined antigenic matrix fluorescence assay (DASS) sensitivity is 89%-100%, radioimmunoassay (RIA) also has high sensitivity, specificity and repeatability, enzyme-linked immunosorbent assay (ELISA), Avidin-biotinylated horseradish peroxidase complex method (ABC-ELISA) is a sensitive and specific common diagnostic method.
(2) Complement binding test (CET): It can be used as a curative effect evaluation, and has certain value for the diagnosis of recurrence. However, its sensitivity is low and false positives are high, so it is not very common, and the bentonite test (BFT) operation Simple, although more specific than CFT, false positives are still high (3.0%-27.8%), so it is not commonly used.
In general, the method for diagnosing cystic echinococcosis can be used to diagnose echinococcosis. The serum IgE is gradually decreased due to the disappearance of hydatid, and its determination can be used as a therapeutic evaluation. The antibody is a competitive enzyme-linked immunosorbent assay (C-ELISA), which is a new method with high specificity, good stability and easy operation. The enzyme-linked immunostaining technique (ELIB) uses Echinococcus granulosus and multi-room The detection of echinococcosis by the nitrocellulose membrane of the echinococcosis antigenic determinant is sensitive, specific, and reproducible. At the same time, ELIB does not need to isolate and purify the antigen.
Knoblocn et al. (1988) isolated two glycoprotein antigens with molecular weights of 20,000 and 48,000 from hydatid cystic sac, and were highly specific for echinococcosis. The antigen with a molecular weight of 20,000 could also differentially diagnose vesicular echinococcosis and cystic packets. Insect disease, it can be used for the differential diagnosis of the above two types of echinococcosis.
PCR technology combined with fine needle biopsy technology, RT-PCR detection of disease-specific tissue-specific mRNA, as a basis for diagnosis and efficacy assessment, to make up for the limitations of traditional imaging and serological diagnostic methods, RT-PCR gene diagnosis compared to Northern Hybridization, in situ hybridization has high resolution, fastness and simplicity, and is suitable for the transcripts closely related to the resolver without relying on its abundance. The result is not affected by DNA variation, and it is a highly specific and sensitive detection technique. .
Second, liver echinococcosis imaging examination
(1) X-ray examination: larger hepatic cystic echinococcosis or hepatic alveolar echinococcosis showed an increase in hepatic shadow, elevated right iliac crest and limited mobility. The person at the top of the liver saw hemisphere in the right iliac crest or Wave-shaped bulge, broken into the brain to show the right lower pleurisy, liquid pneumothorax or signs of pulmonary parenchyma, can be used for gastroscopy to identify the above or below the sacral lesions, calcification of the hepatic cystic hydatid is round or oval, bubble type The hydatid showed diffuse plexus-like or small-circle calcification.
(2) Liver ultrasonography: B-mode ultrasound tomography, cystic hydatid shows a clear liquid-dark zone with visible spots or small light clusters as ascospore; vesicular worms show dense spots, and See the light clusters of different sizes, the bottom light band is not clear.
(3) CT, MRI: Both cystic and vesicular hydatid showed space-occupying lesions and showed the location and extent of the lesion.
Diagnosis
Diagnosis and identification of liver hydatid disease
diagnosis
Clinical manifestation
1 cystic echinococcosis. There is a pastoral life history or a history of close contact with dogs. In the early stage, it was generally asymptomatic. Later, the right upper abdomen gradually found a slow-growing mass, which had a feeling of fullness, discomfort in the liver area, and pain. The liver is swollen and the sac is sexy. When the cyst compresses the common bile duct, it may have jaundice. If the portal vein or vena cava is pressed, ascites may occur and the lower extremity may be swollen. Gastrointestinal compression can manifest symptoms such as indigestion. When the cyst breaks into the abdominal cavity, it produces severe abdominal pain and anaphylactic shock. When the bronchospasm is complicated, the sputum has a powdery skin sample. 2 vesicular echinococcosis. It grows faster, and the liver area can have tingling, pain, and even severe pain. The liver is obviously swollen, and the liver area touches a hard mass with an uneven surface. Late stage is often accompanied by weight loss, jaundice, ascites, fever and so on.
2. Insect test of hydatid cyst fluid (Cassoni test)
For a specific immune response. The method is to filter the non-infected hydatid cyst fluid to the head section, and use it as a stock solution after autoclaving. 0.1 ml of an isotonic saline dilution of 1:1000, 1:100, 1:10 is generally used, starting from a low concentration, and performing an intradermal test on the flexion of the forearm. After 15 minutes, the results showed that red papules appeared locally, and the diameter of the red halo was >1 cm. If the positive reaction occurs after 6 to 24 hours, it is a delayed reaction and still has diagnostic value. The positive rate of this test is 75% to 95%, but there is a false positive.
Differential diagnosis
Primary liver cancer
2 liver benign tumors
3 liver abscess
4 non-parasitic cysts
5 cirrhosis portal hypertension
