Hepatic echinococcosis is one of the most common parasitic diseases, which is based on the formation of cysts in the liver. The main signs of this pathology are general weakness, a significant decrease in appetite, a decrease in body weight, a feeling of heaviness in the liver, nausea after eating fried or fatty foods, stool disorder. To diagnose hepatic echinococcosisr, a general blood test, immunological methods, ultrasound of the abdominal cavity, magnetic resonance imaging, laparoscopy, etc. are used. The most effective treatment is surgical excision of cysts; anthelmintic drugs are also used.
B67.0 Liver invasion caused by Echinococcus granulosus
Hepatic echinococcosis is a parasitic pathology caused by the tapeworm Echinococcus. Its larvae are introduced and multiply in the tissues of the organ, forming cysts. This disease is considered one of the most common helminthiasis. The incidence of echinococcosis varies significantly in different countries of the world. The disease is mainly observed in regions where they are actively engaged in agricultural activities.
Echinococcus parasitizes in the human body exclusively as a larva, affecting not only the liver, but also other organs such as the brain and lungs. At the same time, the involvement of the liver in the process occurs in 65% of all cases of this disease. Gastroenterology and infectology are engaged in the study of pathology. Treatment of echinococcosis is included in the scope of activities of such specialists as an infectious disease specialist, gastroenterologist, hepatologist and surgeon.
Before introduction into the human body, the life cycle of echinococcus includes several stages that follow one after another. The final owner among pets are dogs and, much less often, cats. The parasite lives in the intestines of these animals in the form of mature worms. Their eggs with feces pass into reservoirs, soil, fruits, vegetables, and so on. In the future , there are several options for getting eggs into the human body:
- Part of the eggs is swallowed by small rodents. In the liver of these animals, echinococcus larvae begin to mature. After eating rodents by wild predators, the latter also become infected with parasites. Therefore, with poor heat treatment of game, hunters can get sick with hepatic echinococcosis.
- The other part of echinococcus eggs ends up in the digestive system of agricultural animals, such as pigs, cattle, etc. Eggs enter the mammalian body together with food, grass or water, affecting its organs. Therefore, eating meat without proper treatment can cause the development of hepatic echinococcosis.
- The most common and relevant for humans is the third way of getting the parasite into the body. It is noted with insufficient observance of hygiene rules, which is especially important for children. Echinococcus can enter the gastrointestinal tract when eating unwashed fruits or playing with pets, after which your hands have not been thoroughly washed.
In the human body, larvae are initially absorbed into the blood from the intestine and pass into the liver. In the future, they contribute to the occurrence of hepatic echinococcosis. However, many parasites do not pass from the blood through the hepatic barrier, spreading with the bloodstream to other organs.
Hepatic echinococcosis is a chronic disease that does not have pronounced symptoms, forcing a person to consult a doctor in time. After infection, symptoms do not begin to appear immediately, but after several months or years.
Most often, patients are concerned about general weakness, decreased exercise tolerance, decreased performance, headache, small spot rash on the skin, periodic slight increase in temperature. These clinical signs are the result of toxic products of echinococcus vital activity entering the blood and the body’s reaction to the introduction of parasites. The development of echinococcus in the liver occurs in several stages, each of which has its own clinical features.
The first stage
At the first stage, symptoms may not be observed at all. Therefore, an infected person feels normal and leads an active lifestyle. At this stage, echinococcus is embedded in the liver tissue and forms a protective capsule. The only manifestation of the disease may be a slight discomfort in the right hypochondrium after eating a large amount of food.
The second stage
The second stage is characterized by clear clinical symptoms. In patients, appetite is impaired and body weight gradually decreases. When taking medications, infected people may experience more frequent development of adverse reactions, which is associated with a decrease in detoxification function of the liver against the background of echinococcosis.
Specific symptoms that are characteristic of hepatic echinococcosis are nausea or vomiting, heaviness in the right hypochondrium and diarrhea. Nausea usually develops after eating fatty, fried and spicy foods. Discomfort in the right half of the abdomen worries after eating or against the background of physical activity. Patients with hepatic echinococcosis periodically report diarrhea, which is associated with a violation of the digestion of fatty acids in the intestine due to the inhibition of bile production by hepatocytes.
The third stage
At the third stage of development, hepatic echinococcosis is manifested by complications that are associated with a violation of the integrity of the echinococcal cyst and the spread of parasite eggs to other organs. As a rule, when a parasite enters the bloodstream, an allergic reaction occurs, which is accompanied by bronchial spasm and the development of respiratory failure. In addition, echinococcus can spread to bone tissue, brain, lungs and other organs, causing a violation of their functions.
One of the most frequent complications is considered to be suppuration of the cyst contents, which, when ruptured, can exit into the abdominal or pleural cavity, causing purulent peritonitis or pleurisy. With a large size of the cystic cavity, it can infringe on closely located vessels and bile ducts. The portal vein is most often squeezed from the blood vessels, which is manifested by an increase in pressure in the venous system of the abdominal organs. As a result, the spleen increases and ascites appears.
Less often, an echinococcal cyst compresses the inferior vena cava, which leads to the development of heart failure. This complication is expressed by shortness of breath, swelling of the lower extremities, renal dysfunction and impaired blood supply to internal organs. A frequent complication of liver echinococcosis is compression of the bile ducts, which is accompanied by a violation of the outflow of bile. Symptoms of bile stagnation are yellowing of the skin, itching and stool disorders with a change in its color.
Laboratory and instrumental examination methods are used to diagnose hepatic echinococcosis. A thorough questioning of the patient is also carried out, which allows you to clarify possible ways of infection with this parasite. As a rule, a high risk of the disease is noted in people who are engaged in agriculture and often come into contact with pets.
- Laboratory diagnostics. Blood test, a clinical urine test, immunological tests (complement binding reaction, indirect agglutination reaction) and an allergic test of Cazzoni are performed. In the general blood test, there is an increase in the number of eosinophils and an increase in the rate of erythrocyte sedimentation. Immunological tests are used to determine the presence of antibodies to echinococcus in the blood and cyst contents. They make it possible to accurately diagnose hepatic echinococcosis. Since the function of hepatocytes may be impaired in this disease, biochemical liver tests are carried out to assess it.
- Instrumental diagnostics. Of the instrumental methods, an important role is played by ultrasound of the liver and gallbladder, survey radiography of the abdominal cavity, magnetic resonance imaging and single-photon emission CT of the liver. These visualization methods of examination will allow to identify the cyst and determine its size. They also make it possible to assess the size of the liver, visualize dilated bile ducts, enlarged spleen or ascites.
- Invasive diagnostics. In order to obtain the contents of the cyst and detect parasites, a puncture biopsy of the liver is recommended – but only with the observance of a technique that excludes the contamination of surrounding tissues with echinococcus larvae. Of the invasive techniques, laparoscopy can be used, with the help of which it is possible to directly examine the abdominal organs with a video endoscope.
Hepatic echinococcosis is a parasitic disease that never goes away on its own. At the same time, conservative methods do not allow for a full recovery. Therefore, the only effective way of treatment is surgical intervention. At the preparatory stage, before the operation and in the postoperative period, the appointment of the anthelmintic drug mebendazole is indicated. This drug inhibits the growth of the cyst, reduces its size, significantly reduces the risk of recurrence of pathology.
The most effective method of treatment is surgical removal of the parasite. The operation is associated with a high risk of larval dissemination to the surrounding tissues, therefore it should be carried out by a specialist who knows the technique of minimally invasive parasitic interventions using modern tools. Surgical techniques include excision of liver cysts and endoscopic drainage of liver cysts. After removal of the cyst, germicides are injected into the formed cavity (80-100% glycerin and 30% sodium chloride solution are most effective to prevent recurrence of liver echinococcosis).
Prognosis and prevention
Prevention is aimed at preventing infection with this parasite. It is necessary to thoroughly wash your hands after contact with animals and before any food intake. It is also necessary to carry out a full-fledged heat treatment of meat, which allows you to destroy the echinococcus larvae in it.
Hepatic echinococcosis with timely and competent surgical intervention is curable, however, if detected in the late stages of the disease, even against the background of treatment, it significantly reduces the quality of life, and in some cases pathology can lead to the death of the patient. Relapses occur in about 7% of patients.