Biliary ascariasis in children
Introduction
Introduction to pediatric biliary ascariasis Biliary ascariasis (biliaryascariasis) due to aphid into the biliary tract caused by biliary tract and biliary opening Oddi (Oddi) sphincter spasm caused by abdominal paroxysmal pain, mostly in school-age children, the incidence has decreased significantly in recent years. basic knowledge The proportion of illness: the incidence rate is about 0.01% - 0.05% Susceptible people: children Mode of infection: digestive tract spread Complications: peritonitis shock
Cause
Causes of biliary ascariasis in children
Body factor (30%):
The intestinal dysfunction of the body causes this symptom to occur, such as fever and diarrhea, and the environment in the intestine changes, which promotes the activity of the mites.
Chemical factors (25%):
Insufficient deworming drugs provoke increased activity of mites. The drug or diet changes the pH of the intestine, the aphid is anaerobic, and the low acid can promote the aphid to go retrograde. There are often aphids in the intestines of the children, but generally no symptoms appear.
When hunger, high fever, gastrointestinal tract or improper use of deworming agents, the normal environment of the body, gastrointestinal dysfunction, internal environment changes, plus the aphid have the habit of drilling, the mites can be found Duodenum, when the lower end of the biliary tract sphincter relaxation, insufficiency, biliary dilatation, basophilic aphids are easy to drill into the biliary tract, the mechanical stimulation of the mites into the biliary tract causes the biliary sphincter spasm, also brings biliary infection.
Pathogenesis
When the jejunum and ileum are stimulated, they can be reversed up to the stomach and duodenum; the mites have the habit of drilling. When the Oddi sphincter relaxes, the mites enter the common bile duct, the hepatic duct, and even enter the liver, and the mites enter the biliary tract. After the activity of the worm, the smooth muscle tendon causes severe abdominal pain, and the biliary infection can occur due to bacteria (mainly Escherichia coli), causing liver abscess, which can seriously threaten the life of the child. Ascariasis is mostly the first half of a locust into the biliary tract, but there have been reports of dozens of mites entering a 4-year-old pediatric bile duct. After the mites enter the biliary tract, they can be discharged automatically or passively. There are three forms of mites in the biliary tract:
1 part of the worm in the bile duct, the tail is still in the duodenum, because the head is compressed by the bile duct fistula, the tail is strongly curled to make the worm exit the biliary tract, this form is most common.
2 The worms all entered the bile duct, and then the worm head turned and gradually drilled out.
3 After the worm is dead or paralyzed, it partially rots and is discharged with the bile. However, if a large number of mites enter the biliary tract or the liver, it is not easy to withdraw.
Prevention
Prevention of biliary ascariasis in children
Develop good eating habits, wash hands before and after meals, children over 2 years old should regularly take anthelmintic drugs; enhance physical fitness, strengthen nutrition, enhance resistance.
Complication
Pediatric biliary ascariasis complications Complications peritonitis shock
The main complications of biliary ascariasis are as follows:
1. Biliary tract infection: Most of the infection is Escherichia coli, the child has fever, the tension of the right upper quadrant is widened, and it persists. Sometimes, under the right rib, the painful gallbladder can be felt, and the peripheral blood like white blood cells is increased.
2. Biliary necrosis: The original paroxysmal pain is relieved, but the xiphoid and right flank tenderness area is enlarged, and abdominal muscle tension is present. If necrotic perforation is used, the muscle tension is extended to the left upper abdomen or the lower right abdomen. When biliary peritonitis occurs, total abdominal distension, muscle tension, and sometimes shock occur.
3. Hepatitis and liver abscess: Hepatitis caused by aphids is characterized by large liver and tenderness, high fever, increased white blood cells and elevated transaminases. When abscesses are formed, the original paroxysmal pain disappears, while high fever, hepatomegaly and tenderness are The main symptoms, liver ultrasound can detect single or multiple abscesses, sometimes liver abscess into the armpit or chest, subgingival abscess or empyema.
4. Pancreatitis: As the biliary tract sphincter spasm and aphid block the biliary exit, the pancreatic juice refluxes and acute pancreatitis occurs. The left upper abdomen has tenderness and abdominal muscle tension, and blood and urine amylase increase.
5. Liver, biliary tract bleeding: Aphids move into the small bile duct in the liver. Due to serious infection, hepatic or biliary tract hemorrhage can be caused. It is discharged through the digestive tract and manifests as a large amount of bloody stools, vomiting coffee or hematemesis.
6. Cholelithiasis: Aphid eggs or aphid residues in the biliary tract can become the core and form stones, which are the sequelae of biliary mites, which are rare in childhood.
Symptom
Pediatric biliary ascaria symptoms common symptoms children crying disturbed abdominal muscles tension pale pale appetite loss liver tube obstruction bilirubin calcium stones
There are a history of mites infection , the main symptoms are:
Abdominal pain, vomiting
Sudden onset, sudden on the right upper abdomen severe pain, can not be lying down, bending over, crying, sweating, pale or red, bad spirits, loss of appetite, sometimes vomiting, even spit mites, intermittent pain basically disappeared, Or only the upper abdomen is slightly painful, and after a short period of time, severe pain occurs again. The attack and interval are irregular, which is directly related to the aphid activity. When the aphid dies in the biliary tract or withdraws from the biliary tract, the pain gradually disappears.
2. Signs
There is a small area of tenderness near the right upper abdomen xiphoid. The tender point still exists when there is no seizure. After the complication, the tenderness range increases and abdominal muscle tension occurs, accompanied by fever, and few patients have jaundice.
Examine
Examination of biliary ascariasis in children
1. stool examination: eggs can be found, fecal occult blood can be positive.
2. Peripheral blood: When infected, there is infectious blood, increased leukemia count and increased neutrophils.
3. Blood biochemical examination: transaminase can be increased when causing hepatitis.
4. Duodenal drainage examination: the duodenal drainage fluid can be seen in eggs.
5. Barium meal or duodenal injection angiography: visible mites in the duodenum.
6. Oral or intravenous cholangiography: worm shadows can be detected in various parts of the biliary tract.
7. Duodenal retrograde cholangiography: The most reliable diagnostic method is retrograde cholangiography or decoction by fiber duodenoscopy.
8. B-ultrasound: can show the expansion of the common bile duct and the shadow of the mites.
Diagnosis
Diagnosis and diagnosis of biliary ascariasis in children
diagnosis
1. Clinical features: a history of fecal or worms, a history of deworming, paroxysmal upper abdominal pain and tenderness on the right side of the xiphoid.
2. Laboratory examination and auxiliary examination results: Do duodenal drainage, three parts of drainage fluid can have mites eggs, according to the above can make a diagnosis.
Differential diagnosis
It is differentiated from cholecystitis, cholelithiasis and pancreatitis, but this disease can cause the aforementioned complications, relying on medical history and auxiliary examination to assist in differential diagnosis.
