Overview
Biliary parasitosis is a disease in which parasites enter the biliary tract and cause a series of specific clinical manifestations. The most common biliary parasites are Ascaris lumbricoides and Schistosoma chinensis.
Causes
1. Ascaris lumbricoides, which normally parasitizes in the small intestine, causes the disease due to the change of parasitic environment, such as starvation, hyperthermia, decrease of gastric acid, gastrointestinal dysfunction, improper deworming, pregnancy and so on, and then goes up to the biliary tract.
2. Chinese branch testicular schistosomiasis is more prevalent in the south, after eating raw fish and shrimp contaminated with eggs of Chinese branch testicular schistosomiasis, Chinese branch testicular schistosomiasis cysts will be decapsulated in the duodenum after gastric juice is used, and the larvae will develop and grow up through the common bile duct to the hepatic bile ducts, which will cause the disease.
Symptoms
1. Patients with biliary ascariasis have the following symptoms: ① paroxysmal colic, pain located under the raphe, paroxysmal, sudden and sudden stop. During the attack, the patient is restless and sweating profusely; during the relief, the patient is calm as usual. This is the roundworm drilled into the bile duct caused by spasm of the sphincter of Oddi (Oddi). ② When the worm completely into the bile duct, colic can disappear or turn into persistent pain and discomfort. ③Deep compression pain under or to the right of the raphe on examination, but no obvious muscle tension and rebound pain. ④ When secondary bacterial infection is caused, the patient develops chills, fever, jaundice, and even pancreatitis, liver abscess, biliary hemorrhage and other manifestations.
2. Patients with biliary Chinese branch testicular schistosomiasis do not have typical clinical manifestations, and mainly manifest gastrointestinal symptoms such as dyspepsia, abdominal distension, and hepatosplenomegaly, cirrhosis and so on.
Examination
1. Mild leukocytosis, increased eosinophil count, and detection of Ascaris lumbricoides eggs in the feces are helpful in the diagnosis of biliary ascariasis. In addition, ultrasound, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) and other tests can also assist in the diagnosis of biliary ascariasis.
2. There is no specific test for biliary Chinese branch testicular schistosomiasis.
Diagnosis
1. Biliary ascariasis can be diagnosed according to the typical clinical manifestations, i.e., severe abdominal pain with mild signs and symptoms, sudden onset of pain, history of deworming or vomiting of roundworms before the disease.
2. The diagnosis of biliary Chinese branch testicular schistosomiasis is mainly based on epidemiologic history.
Treatment
The treatment of biliary parasitic disease focuses on prevention and treatment, once the onset of disease, should be analgesic, antispasmodic, deworming, anti-infection and other non-surgical treatment. Surgery is considered when treatment is ineffective or complications occur (e.g., complete biliary obstruction, acute suppurative cholangitis, biliary hemorrhage, liver abscess, etc.).