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Echinococcosis of the liver
Last reviewed: 23.04.2024
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[How does liver echinococcosis develop?
The source of infection are dogs that eat the innards of infected sheep and cows. Infection of a person occurs with the consumption of food contaminated with helminth eggs, released into the external environment with feces of dogs and wolves. A person can catch and iron a dog. When the egg passes through the duodenum, a larva enters from it into the intestinal wall, and then it enters the liver with a blood stream, where the larvae are most often retained.
The parasite that has settled in the liver can be destroyed under the influence of the protective mechanisms of the host or slowly develop into cysts with a diameter of up to 20 cm or more.
The content of echinococcal cysts is a transparent liquid, where the daughter and grandchildren - scolexes - swim.
Echinococcal cyst has a formed capsule, and its growth occurs within the capsule due to compression of surrounding organs and tissues. In contrast, alveococcosis is characterized by invasive growth, as a result of which the node sprouts into neighboring organs.
Complications of echinococcosis are associated with the growth of the cyst and with the squeezing of its vessels, bile ducts. Possible rupture of the cyst with the release of the contents into the free abdominal cavity, bile ducts.
Alveococcosis is characterized by small white or white-yellow vesicles interspersed with inflammatory altered and necrotic surrounding tissue. The vesicles are tightly fixed to the surrounding tissue, and isolated excision is impossible. The dimensions of individual bubbles do not exceed 3-5 mm, but their clusters can form nodes up to 15 cm or more in diameter. Alveococcosis is characterized by infiltrating growth and multiplication of parasite vesicles as external budding. Because of this, long-term nodes have a tuberous form, they are dense to the touch, so sometimes a malignant tumor is mistakenly diagnosed.
Multiple invasion of alveococcus can simulate metastatic liver tumors.
Alveococcal nodes of large sizes are subject to necrotic decay; beginning at the center of the node and leading to the formation of one or more cavities, often containing sequestration of necrotic tissue.
Due to invasive growth, the alveococcal nodes grow into the vessels and bile ducts, and when located at the surface of the liver - into neighboring organs (stomach, gall bladder, diaphragm, adrenal, spine), the more their similarity to a malignant tumor increases.
Symptoms of liver echinococcosis
With liver echinococcosis, the symptoms of the disease are manifested only with a significant increase in the size of the cyst and compression of neighboring organs, primarily large vessels (including the portal vein), and the violation of blood flow in them. In some cases, there is a long asymptomatic course. In others, the general condition deteriorates rapidly.
There are three stages (periods). The first stage is from invasion of the parasite to the appearance of the first symptoms. The second stage - from the appearance of the first complaints before the onset of complications of echinococcosis. The third stage includes manifestations of complications of the echinococcal cyst. The first stage of the disease is asymptomatic. On the second, weakness develops, appetite worsens, and weight loss occurs. Appear dull pain, a sense of heaviness, pressure in the right hypochondrium. There are allergic reactions in the form of urticaria, diarrhea, vomiting. Uncomplicated liver echinococcosis has a rather favorable prognosis.
However, there is a risk of complications (third stage). There may be suppuration of the cyst, its perforation with a breakthrough into the cavity or organ, severe allergic reactions to the antigens of echinococcus.
Serious complications are ruptured cysts in the abdominal and pleural cavities. The breakthrough of the cyst into the bile ducts is not so dangerous, since its drainage may occur. In addition, a secondary infection of the cysts is possible.
If the cyst is squeezed intra- or extrahepatic bile ducts, jaundice may occur. With suppuration cyst pain worse in the right hypochondrium, progressing intoxication, body temperature rises to 40-41 ° C.
Possible breakthrough abscess in the pleural cavity, as well as in the retroperitoneal space Sometimes the cyst can emptied into one of the neighboring organs - stomach, intestine, bronchi, gallbladder, intrahepatic bile ducts.
More often echinococcal cysts are located in the right lobe of the liver, on its anterior-lower or posterior-lower surface. Dissemination of the process and the formation of daughter blisters can be accompanied by a severe lesion of the abdominal cavity.
Echinococcosis of the liver can lead to death, but as a result of the use of antibiotics, the prognosis becomes more favorable.
In patients with alveococcosis, the progression of the disease manifests itself as jaundice, an increase in the spleen, and in some cases - ascites. Decay of the node may occur with the formation of a cavity, in 20% of cases, there is germination of nodes with multiple localization to other organs.
Alveolococcosis with the flow resembles a local malignant tumor.
Diagnosis of liver echinococcosis
The diagnosis of liver echinococcosis is based on:
- instructions in the anamnesis for a stay in a terrain endemic for echinococcosis;
- detection of palpation of a dense cyst associated with the liver;
- positive serological reactions (latex-agglutination reactions, passive hemagglutination, etc.);
- revealing a pathological focus in the projection of the liver by ultrasound, computed tomography, angiography of the blood vessels of the liver.
Alveococcosis is characterized by the same criteria, but palpation does not reveal a dense elastic cyst that is associated with the liver. The palpable alveococcus node has a stony density, its boundaries are indistinct, gradually transform into a healthy parenchyma of the liver.
Serologic studies can identify antibodies to Echinococcus antigens. Currently, serological reactions are used: latex agglutination (RIA), double diffusion in the gel, indirect hemagglutination, immunofluorescence (IGF), ELISA.
X-ray changes include high standing and limiting the mobility of the diaphragm, hepatomegaly, calcification of ectocysts, which on the roentgenogram appears as a rounded blackout.
When ultrasound or CT scan, single or multiple cysts are detected, which can be single or multi-chambered, thin and thick-walled. "With MRI, a characteristic intensive contour, daughter cysts and stratification of the cysts are found. With ERCPH, bile duct cysts are found.
Treatment of liver echinococcosis
Surgical treatment of liver echinococcosis is the main method. To date, there are no effective conservative measures to control the invading parasite. In addition, the death of echinococcus is not a cure for the patient. As a rule, in this phase there are various complications: suppuration, perforation or hemorrhages in the echinococcal cyst, etc.
The threat of rupture and secondary infection of cysts during echinococcosis is so great that if they are few, they are large and allow the patient's condition, surgical treatment is necessary.
As a drug treatment may be used mebendazole or albendazole. However, they are not effective enough for large cysts of the liver; possible relapse of the disease.
Antibiotic therapy of alveococcosis is effective, but does not cure completely. Without complete surgical removal of the affected tissue, the disease leads to a lethal outcome. Alveococcosis may require liver transplantation.