Echinococcal liver cyst: how to diagnose and treat. How does liver echinococcosis manifest and how to treat it

Often found in people. According to modern data, echinococcosis is unevenly distributed across globe. The most numerous cases of the disease are observed in countries where agricultural activity dominates. Echinococcus can affect any organ, but in most cases the dominant position is occupied by damage to organs such as the liver, lungs and brain.

Echinococcus - who is it?

So, what is echinococcosis? To clearly answer this question, it is necessary to understand the numerous types of parasites. Echinococci are tapeworms that parasitize the intestines of dogs, wolves, and foxes. The overall size of the worms does not exceed a few millimeters; if you look closely, they can be seen with the naked eye.

There are two types of echinococcus:

Second phase along with the manifestation general symptoms, described above, is characterized by the appearance of symptoms of liver damage. Patients lose their appetite and their body weight gradually decreases. Upon admission medicines Undesirable side reactions are possible due to the reduced ability of the liver to neutralize chemicals.

TO specific symptoms liver damage includes:

Nausea or vomiting that appears after eating: fried, fatty, food, or other savory dishes.
The appearance of heaviness in the right hypochondrium and pain in the upper abdomen with its displacement to the right hypochondrium, also after eating or after increased physical activity.
Stool disorder in the form of periodically appearing diarrhea. It occurs as a result of impaired digestion of fats in the intestines due to impaired bile secretion by the liver.

When examining the patient, a significant increase in the size of the liver can be detected. When palpated, the liver is painful and dense. Data pathological symptoms characteristic of hepatitis (liver inflammation). If the diagnosis is incorrect, liver inflammation can be treated for a long time and without success. Since the liver has a great regenerative capacity, despite significant damage to the liver tissue, liver failure does not arise.

Third stage or the stage of the disease is characterized by the appearance of complications associated with the rupture of an hydatid cyst and the spread of helminth eggs throughout the body. If during the first stages of the disease there were only general symptoms and signs of liver damage, now there will be serious disruptions in the functioning of other organs and systems. The most common complications may be:

Cyst suppuration with the formation of purulent contents inside it. When an abscess ruptures, pus may enter the abdominal cavity with the development of peritonitis (acute purulent inflammation of the peritoneum - the lining of the abdominal organs). When a cyst breaks into the chest cavity, inflammation of the membranes of the lungs develops - purulent pleurisy.
Cyst rupture often accompanied by the entry of its contents into the blood. In this case, in almost all cases, a pronounced allergic reaction appears, since a large amount of biologically active substances is released, which contribute to the formation of tissue edema, the appearance of varying intensity skin rashes, narrowing of the airways with the appearance of shortness of breath and many other manifestations characteristic of allergies. In addition, echinococci spread throughout the body and enter the lungs, brain, bones and other organs.
A large cyst can press on surrounding tissue, including the portal vein and intrahepatic bile ducts. The following symptoms may occur:

When squeezing intrahepatic bile ducts symptoms arise due to stagnation of bile in them and increased pressure in the liver tissue. Normally, bile is produced in the liver from destroyed red blood cells and bile acids, then goes to gallbladder, then in small intestine. The function of bile is that it helps digest incoming fats from food. If this physiological cycle does not occur, then the gradual increase in bile pressure in the small hepatic bile ducts will lead to the fact that bile will eventually leak into the blood. This complication is called mechanical or obstructive jaundice. The patient is all yellow with greenish tint, constantly feels itching of the skin, and the urine becomes “the color of strong tea or beer.”
When the lumen of the portal vein closes, there is an increase in blood pressure in the circulatory system those organs of the abdominal cavity, the outflow of blood from which is directed to the liver. These include: stomach, part of the esophagus, small and large intestines, spleen. Observed clinical picture disorders of these organs. But the main signs of impaired blood flow are an enlarged spleen and the appearance of ascites (fluid accumulation in the abdominal cavity). Occurs due to high blood pressure blood in the portal vein system.
When the lumen of the inferior vena cava, blood from which enters the right side of the heart, is closed, a picture of cardiovascular failure is observed. Symptoms are due to insufficient income blood to the heart and lungs. The blood is not saturated with oxygen - shortness of breath appears, plus the blood supply to all organs of the body suffers, primarily the heart, kidneys and brain. Appear frequent losses consciousness, pain in the heart, kidney dysfunction and many other disorders associated with insufficient blood supply to organs and systems.

Symptoms of pulmonary echinococcosis

There are also several stages in the development of the clinical picture that develops when the lungs are damaged. At the initial stage, when echinococcus penetrates into pulmonary system a cyst is formed, which slowly but grows and increases in size. There may be several such cysts, in which case the symptoms of the disease begin to appear faster. In parallel with the specific symptoms of lung damage, there are also general symptoms of malaise, chronic fatigue and decrease general performance, as with liver damage.

At an early stage of lung damage There are symptoms such as:
A dry hacking cough, which over time acquires a specific unpleasant odor and becomes moist and foamy. Subsequently, streaks of blood appear from time to time, which can be confused with a tuberculosis process or cancerous tumor lungs.
Chest pain is observed in cases where the cyst becomes large and compresses the pleura (the lining of the lungs), which is abundantly supplied with sensitive receptors.

Alveolar echinococcosis
One of the subspecies of echinococcus causes exactly the same clinical picture of the disease as with hydatiosis echinococcosis. The only difference is that this echinococcus forms not one large cyst, but several cystic blisters of small diameter. In addition, they have the ability to penetrate surrounding tissues and accordingly destroy them. Symptoms of the disease appear much earlier and are more severe. The consequences of alveolar echinococcosis are much more dire, since by destroying the organ, cysts lead to its failure, and also quickly spread through the blood to all organs and tissues. It is no longer possible to treat such echinococcosis.

Diagnosis of echinococcosis

To diagnose echinococcosis, it is necessary to carry out both laboratory and instrumental methods research using modern computerized devices. Clinical symptoms of damage to a particular organ also play an important role. Of course, it is impossible to do without modern diagnostic methods, but a timely survey about the patient’s life history, his type of activity, and when he first discovered the first signs of the disease may sometimes suggest the existence of echinococcosis.

For example, a man has been involved in livestock farming for 40 years and is constantly in contact with sheep, pigs and other livestock. He also loves dogs very much and can play with them for a long time. Complains of periodic pain in the right hypochondrium.

To the first group, that is, confirming the diagnosis includes immunological tests that are carried out in biochemical laboratories. On this moment There are a number of tests that confirm whether specific proteins are present in the blood or cyst contents - antigens characteristic specifically for echinococcosis. Also, using these reactions, it is possible to determine the presence of protective proteins produced by the body to neutralize antigens.
This category of tests includes:

RSK – complement fixation reaction
RNGA– indirect hemagglutination reaction

This can also include allergies Cazzoni's sample.
A scarifier is used to make a small scratch on the front surface of the forearm, then a small amount of liquid from the hydatid cyst is dripped on top. The liquid is prepared in advance and stored for a long time under special conditions. The liquid contains echinococcal antigens. The essence of the method is that if a patient has echinococcosis, then he must also have antibodies to them. When antibodies bind to antigens, a local inflammatory reaction occurs, which manifests itself in the form of local redness and slight swelling of the tissue in the area of the scratch.

Second group laboratory tests involve identifying specific changes in the blood when target organs are damaged.

If the liver is damaged, abnormal liver tests are detected.

Ultrasound examination of the liver
Mainly used to examine the abdominal organs, detecting liver enlargement or cyst-like formations.

X-ray methods. These include:

Plain chest x-ray– with the help of which cyst-like formations in the lungs are determined. Also, during a protracted process, deposition of calcium salts around the cysts is detected.

CT scan– also an x-ray method that reveals deeper tissue defects. It is used in the diagnosis of echinococcosis of the lungs, liver and other organs.

Treatment of echnococcosis is carried out only surgically. During the period before and after the operation, concomitant treatment anthelmintic drug – mebendazole (Vermox).
The dose is prescribed individually depending on the stage of the pathological process. In some cases, this approach using mebendazole can temporarily delay the growth of the cyst and even reduce it in size.

Surgery consists in removing the echinococcal cyst with the capsule and surrounding, pathologically altered tissues. A cyst is removed in cases where it is small in size and located closer to the surface of the organ.

In cases of deep cystic formation, in order to avoid complications associated with damage to deep vessels and bile ducts, a different surgical approach is used. The cyst along with the capsule is not removed, but its contents are first punctured and its contents are sucked out. Then the inner layers of the cyst are cleaned from the inside, after which the cavity is treated with a 2% formaldehyde solution and sutured.

For alveolar echinococcosis They perform so-called palliative operations, which do not completely cure the disease, but only temporarily alleviate the suffering of the patient. They are carried out by removing part of the largest cysts to reduce compression of the healthy part of the organ. Palliative operations are performed to increase the patient's life expectancy, as well as to improve his well-being.

Recovery criteria

A person is considered healthy if immunological blood tests are taken from him for four years and they show a negative result.

Prevention of echinococcosis

Preventive measures include a whole range of measures taken to prevent possible infection echinococcosis. First of all, it is necessary to remember the routes of transmission of infection in order to reduce the risk of infection to a minimum.

People whose work is related to dog breeding, hunting, animal husbandry, and members of their families must first of all pay great attention to the hygiene rules that are followed:

After contact with dogs and other animals
Before meals
After the toilet

Timely washing of hands with soap after the above steps will prevent infection from entering the body.
It is important to know that water from springs, wells and other natural sources First of all, they boil it, and then they drink it.
Careful heat treatment of meat is also very important because it may contain echinococcus larvae.
Those ill with echinococcosis after treatment must be registered at the dispensary, and visit a doctor and be examined at least once every 2 years. Clinical examination is carried out for 8-10 years.

How to recover after surgery for echinococcosis?

In any case, surgery to remove an hydatid cyst disrupts the functioning of the damaged organ. And it is very important to properly rehabilitate after surgery, restore the function of the organ as much as possible and prevent the development of relapses of the disease.

What should be done after surgery for echinococcosis?
1. Accept anthelmintics according to the regimens (Mebendazole).
2. Rehabilitation after surgery for echinococcus lasts at least 2-4 months(the patient is recommended to take sick leave for the recovery period).
3. Mandatory examination 2 times a year for the first 2 years, then 1 time a year for 8-10 years:

blood for antibodies to echinococcus;
X-ray of the lungs;
liver tests and blood biochemistry;
computed tomography of the head (after surgery for echinococcosis of the brain or in the presence neurological symptoms);
general blood and urine analysis;
other types of examination as indicated.

4. Maintaining personal hygiene rules.
5. Eating thermally processed foods.
6. Limit contact with animals, which can cause re-infection with helminths, or strictly adhere to hygiene after contact with them.
7. Healthy lifestyle, quitting smoking, alcohol, drugs, daily light physical activity.
8. After liver surgery:

necessary follow a diet, table No. 5a: complete nutrition with high content protein, carbohydrates, vitamins and microelements, with the exception of fats, cholesterol and coarse fiber;
take medications that restore liver cells: essential phospholipids - Essentiale, Enerliv, Livolin, Liv-52 and others.

9. After lung surgery: after a month a special treatment is recommended breathing exercises and exercise therapy aimed at improving lung ventilation.
10. After surgery for cerebral echinococcosis:

drugs that improve blood circulation in the brain: Actovegin, Cerebrolysin, Piracetam and so on;
physiotherapy aimed at restoring motor functions;
classes with a speech therapist for speech dysfunction;
psychotherapy for mental disorders in the patient.

What should you avoid after surgery for echinococcosis?
1. From heavy physical activity for 4 months,
2. from physiotherapy earlier than 2 months after surgery,
3. It is not advisable for women to become pregnant,
4. from psycho-emotional stress.

Is it possible to cure echinococcosis using traditional medicine and without surgery?

Traditional medicine is powerless to cure echinococcosis without surgery, since there are no means that would “resolve” hydatid or alveococcal cysts.
However, traditional medicine can be used to prevent relapses after surgery or with multiple echinococcosis, when surgery does not seem possible.
To do this, use various herbal ingredients that have an anthelmintic effect, and also contain necessary substances to restore to postoperative period.

Traditional medicine against echinococcus:
1. Sagebrush: dry the herb and chop it, take one pinch, gradually increasing the dose to a quarter tablespoon, 1 time per day, every day, for a total of 3 weeks; drink plenty of water, after which it is recommended to take wormwood once a week for several years.
2. Lemon zest + ginger in a ratio of 1:1, dry and grind, stir, before taking the mixture, pour 50.0 ml of water or milk, drink in the morning on an empty stomach every day.
3. Lemon + garlic + honey: Grind 1 lemon, add a couple of heads of chopped garlic and 10 ml of honey, pour it all with 1000.0 ml of water, take 30.0 ml on an empty stomach daily, the treatment is long-term.
4. Tansy infusion(not for pregnant women): pour 1 tablespoon of the herb into 200.0 ml of boiling water and leave for 4 hours, take 10 ml 4 times a day 15 minutes before meals, the course of treatment is 1 week.
5. Black peppercorns: Take 1 pea daily in the morning on an empty stomach with a glass of water.
6. Wormwood + tansy + wormwood: take equal portions of herbs, dry and grind, take 1 teaspoon on an empty stomach with a glass of liquid for 10 days, then repeat the course every few months.

Is Echinococcus transmitted from person to person?

A person becomes infected with echinococcus through contact with sick animals and consumption of contaminated food products (both meat and plant foods).

In the chain of life of Echinococcus, humans are the intermediate host. In this regard, humans stand in the same niche as pigs, sheep and other herbivores. An intermediate host is needed for the helminth only for the maturation of the larvae. Mature larvae enter the body final owner(dogs, cats, wolves and other predators) after eating meat or internal organs sick animals. Man does not eat his own kind (at least in modern civilized society), so he is a dead end in the biological chain for the development of echinococcus. That is, a person cannot become infected from a person through household and contact contact.
Theoretically, a person suffering from echinococcosis has a minimal risk of becoming infected by a surgeon during an operation or by a pathologist during an autopsy of a corpse suffering from echinococcosis. This can happen if doctors fail to comply with basic hygiene rules, which in principle is nonsense.

Does echinococcus occur in children? What are the signs, diagnosis and treatment of echinococcosis in childhood?

Children also suffer from echinococcosis, and their risk of contracting helminthic infestations is much higher. After all, kids really love to play and kiss cats and dogs, eat straight from the garden, and really don’t like washing their hands with or without reason.

Another question is when the disease is detected, because the hydatid cyst grows slowly, over years, and sometimes tens of years, while symptoms of the disease are often absent, so echinococcosis is more often detected in adolescent children and young adults. IN childhood Echinococcal cysts are detected, in most cases, as an accidental finding (x-ray for a positive Mantoux test, pneumonia, ultrasound of the abdomen for suspected biliary dyskinesia, and so on).
Echinococcosis is also detected during serological blood tests if other helminthic infestations are suspected (giardiasis, ascariasis, toxocariasis, and others). And the standard tablet also includes tests for echinococcus. If antibodies to echinococci are detected, additional instrumental studies of the liver, lungs, brain and other organs are carried out.

Signs and symptoms of echinococcosis in children:

poor appetite resulting in weight loss;
weakness, learning retardation, impaired concentration;
subjective sign: grinding teeth in a dream;
restlessness, irritability, mental agitation in a child for no reason;
Other types of worms are often detected (pinworms, lamblia, roundworms);
abdominal pain, often in the right hypochondrium, nausea, vomiting, abnormal bowel movements (diarrhea or constipation);
yellowness of the skin, various rashes are possible;
dry cough, often at night;
shortness of breath, chest pain – with pulmonary echinococcosis;
severe headaches (if the cyst is localized in the brain);
increase in the number of eosinophils in general analysis blood and the level of immunoglobulin E in the blood;
when cysts rupture general state sharply worsens, body temperature rises, severe shortness of breath, weakness, possible hemoptysis, in severe cases with alveococcosis of the liver, liver failure develops.

The principles for diagnosing echinococcosis in children are the same as in adults:

blood test for antibodies to echinococcus;
Ultrasound of the abdominal cavity and kidneys;
chest x-ray;
computed tomography of the liver, brain and other organs, depending on the clinical picture of the disease;
clinical blood and urine tests, liver tests, blood biochemistry and so on.

Treatment of echinococcosis in childhood, as in adults, most often surgical with removal of cysts or their opening, removal of contents and washing of echinococcal cysts. Antihelminthic drugs are also prescribed: Mebendazole, Albendazole and their derivatives for long period(up to 10 months) according to individual plans.
Recovery in the postoperative period in children is even easier than in adults, since they have more developed compensatory mechanisms and regenerative and healing abilities.

What does echinococcus look like (photo)?

Photo: Postoperative material(macropreparation) of a removed alveococcal cyst of enormous size.

And this is what it looks like Echinococcus with egg under a microscope.

Photo: plain X-ray of the chest organs of a patient with echinococcosis. In the upper lobe of the left lung there is a rounded shadow with clearing in the center. The X-ray picture is very similar to the picture of infiltrative pulmonary tuberculosis with destruction lung tissue(cavern). Without additional research it is impossible to figure it out. Echinococcus is often discovered during surgery for pulmonary tuberculosis.

Computed tomography section of the liver with an hydatid cyst.

And this is what they look like emptied hydatid cysts As you can see, the walls of the cyst are very thick, and the cysts themselves are large. Therefore, the only way to treat echinococcosis is surgical method, the body and medications do not have as many opportunities to promote the resorption of these formations.

And this is what it looks like liver of an animal with echinococcosis. Having discovered such a liver, under no circumstances should it be cooked or eaten, or fed to domestic animals; this is the most common cause of infection of humans, dogs and cats with echinococcus.

Symptoms of echinococcosis in dogs and cats:

poor appetite;
bowel dysfunction in the form of diarrhea;
loss of animal body weight;
The fur of such animals is dull and thick;
from playful animals they become lethargic, tired, drowsy;
cats and dogs begin to intensively lick the anal area, rubbing this area against the ground or wall;
In the general blood test, the number of eosinophils was increased, the level of hemoglobin and red blood cells was reduced.

Echinococcosis in sheep, pigs and other livestock
Sheep, pigs, cows and other livestock, like humans, are intermediate hosts of echinococcus; the manifestations of this disease are very similar to those in humans. That is, echinococcal cysts form in livestock, most often in the liver and lungs.

Symptoms of echinococcosis in sheep, cows, pigs and other livestock:

often observed asymptomatic diseases that are associated with the slaughter of livestock at the age of 1-2 years, during which time echinococcal cysts do not reach large sizes and, therefore, do not cause symptoms;
livestock falls - animals die, and only when their carcasses are opened can echinococcal cysts be identified;
cough, shortness of breath (with pulmonary echinococcosis);
refusal to eat, weight loss, diarrhea (with echinococcosis of the liver);
positive intradermal Kasoni test (special diagnostic test for detection of antibodies to echinococcus).

When slaughtering and consuming the meat of such animals, it is necessary to carefully examine the internal organs, especially the liver and lungs. A change in their color, size, wrinkling, the presence of various bubbles and other inclusions should alert you. Suspicious organs must be disposed of. The meat of such animals must undergo thorough heat treatment before it reaches the table. When cutting a carcass, it is necessary to observe the rules of personal hygiene, wash your hands thoroughly, and thoroughly clean boards, knives, axes and other cutting objects.

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Liver echinococcosis

What is liver echinococcosis - Liver echinococcosis (echinococcosis hepatis)

- human helminthiasis caused by the penetration and development in the liver of tapeworm larvae Echinococcus granulosus and E. (Alveococcus) multilocularis.

Liver echinococcosis occurs in two varieties - cystic and alveolar (multi-chamber). In Russia and neighboring countries, echinococcosis is widespread mainly in Central Asia, Kazakhstan, Georgia, Crimea, Siberia (Novosibirsk, Omsk, Tomsk regions), Yakutia.

What provokes / Causes of liver echinococcosis: The causative agent of human echinococcosis is the larval stage of the tapeworm Echinococcus -.

Echinococcus granulosus

The sexually mature form of echinococcus is a small cestode 2.5 - 5.4 mm long, 0.25 - 0.8 mm wide. It consists of a pear-shaped scolex, a neck and 3 to 4 segments.

The scolex is equipped with four suckers and a crown of two rows of hooks (28 - 50). Behind the scolex there is a short neck and segments, the first two are immature, the third is hermaphroditic and the fourth is mature. The mature segment (length 1.27 - 3.17 mm) is filled with a stretched uterus, which is a wide with lateral protrusions. The uterus is filled with eggs (400 - 600 pieces), which do not differ in structure from the eggs of bovine and pork tapeworms (teniids), containing a six-hooked oncosphere inside.

Hydatid cyst is a bubble of a very complex structure. Outside, it is surrounded by a layered shell (cuticle), the thickness of which sometimes reaches 5 mm. Under the multilayer cuticular membrane lies a thin internal embryonic (germinative) membrane, which produces brood capsules with scolex, daughter vesicles, and also gives rise to the layered membrane.

Brood capsules are small bubble-like formations scattered on the embryonic membrane and connected to it by a thin stalk. They have the same structure as the main bladder, but with the reverse arrangement of the membranes (germinative on the outside, layered on the inside). Each brood capsule contains scolex attached to its wall, screwed inward and having a structure typical of tapeworms. The bladder is filled with liquid, which plays the role of a protective nutrient medium for brood capsules and scolex.

The liquid may contain freely suspended, detached scolex and brood capsules, the so-called hydatid sand.

The bladder is gradually covered with a connective tissue membrane. Often, such a maternal cyst, in addition to the above elements, also contains so-called daughter blisters, which have the same structure, and inside them are grandchild blisters.

Such cysts are observed in humans. Sometimes daughter blisters form not inside the mother cyst, but outside. Such bubbles are called exogenous.

Echinococcal cysts that form in animals, as a rule, do not contain brood capsules and scolex; they are called acephalocysts. This form is not found in humans.

In the sheep-breeding areas of the southern zone, the circulation of echinococcus follows the following pattern: sheep -› guard dogs accompanying the flock -› sheep.

In the western regions of intensive pig farming, the circulation of echinococcus follows the pattern: pigs -› dogs -› pigs. The absence of active motor function in members of the “pork” strain reduces contamination of dog hair and soil, thereby limiting the conditions for infection of people and animals.

The intensity of transmission of invasion is determined, first of all, by the number of sources of invasion of the definitive hosts and the amount of invasive material released by them - oncospheres and segments.

Oncospheres tolerate temperatures from -30°C to +38°C; on the soil surface in the shade at a temperature of 10 - 26°C they remain viable for a month, but in the sun at a temperature of 18 - 50°C they die after 1-5 days. In grass at a temperature of 14 - 28°C they die no earlier than after 1.5 months. Oncospheres are well tolerated low temperature, in which they can persist for a number of years, but are very unstable to drying out.

Humans, the intermediate host, are a biological dead end.

In human echinococcosis, the dog occupies the primary position as the definitive host. Dogs become infected by eating meat waste from slaughterhouses, slaughterhouses, kitchens, or by feeding them confiscated goods from slaughterhouses or organs infected with larvocysts from animals slaughtered at home. Dogs can also become infected by feeding them hunting products - damaged organs or carcasses of wild herbivores.

The routes of infection of intermediate hosts are also different; herbivorous farm animals become infected by ingesting eggs, helminth segments with grass, hay, water, contaminated with the feces of infested dogs. Pigs, being coprophages, become infected by eating dog feces. The main role in infecting a person through dirty hands is played by communication with infested dogs, on whose fur and tongue there may be eggs and segments of Echinococcus tapeworms. Healthy animals can also transmit the infection to humans as mechanical carriers of eggs, which contaminate their fur and tongue when licking an infected dog.

Human infection cannot be ruled out by eating unwashed vegetables, berries, fruits contaminated with dog feces containing oncospheres.

A person can also become infected from wild carnivores during hunting, cutting skins, making fur clothing, as well as by eating unwashed wild berries, and drinking water from natural bodies of water.

In sheep-breeding areas, where the circulation of the pathogen occurs mainly between dogs and sheep, risk groups include shepherds, shepherds accompanying flocks, as well as sheep shearers and family members.

Pathogenesis (what happens?) During liver echinococcosis:

Echinococcosis develops in connection with the introduction and growth of tapeworm larvae, echinococcus, in various organs.

A person becomes infected with echinococcosis mainly orally, and due to the hematogenous route of spread, oncospheres can affect any organ, any tissue, but most often the liver (44 - 85%), then the lungs (15 - 20%) in more in rare cases throughout the systemic circulation - kidneys, bones, head and spinal cord and other organs.

The pathological influence of echinococcus is due to the mechanical and sensitizing influence of the growing larva. Cysts range in size from 1 - 5 cm in diameter to giant cysts containing several liters of fluid. The mechanical impact of such a cyst leads to dysfunction of the affected organ. Localization and size determine the main symptomatology and severity of the disease.

Symptoms of liver echinococcosis:

There are two forms of echinococcosis: cystic (hydatid) and alveolar. Hydatid form echinococcosis is a disease caused by the cystic or larval stage of development of the echinococcosis tapeworm Echinococcus granulosus.

For a long time (sometimes for many years), starting from the moment of infection, there are no clinical signs of the disease, and the person feels practically healthy. Clinical manifestation of the disease begins only when the hydatid reaches a fairly large size. Dull, aching, constant pain occurs in the right hypochondrium and epigastric region, lower sections right half of the chest. Upon examination, in case of large cysts, one can detect a bulging of the anterior abdominal wall in the area of the right hypochondrium. Percussion reveals an upward expansion of the liver boundaries. Upon palpation of the liver, a round, elastic consistency tumor-like formation can be identified (if large echinococcal cysts are localized in the anterior lower parts of the liver). When cysts are localized deep in the liver parenchyma, hepatomegaly is observed.

Based on localization, there are three types of liver echinococcus: anterior, descending (abdominal) and ascending (thoracic). With a large volume of anterior cysts, the liver area greatly expands. Upper cysts simulating effusion pleurisy are determined fluoroscopically by the high position of the diaphragm on the right with a dome-shaped protrusion of the location of the cyst. With lower cysts, the tumor can be palpated in the abdominal cavity, it moves when breathing with the liver, and has an elastic consistency. Cysts localized in the left lobe of the liver become accessible to palpation in more later periods diseases.

Rupture of a hydatid cyst can occur with the outpouring of contents into a peculiar abdominal cavity, into the gap gastrointestinal tract, into the bile ducts, into pleural cavity or into the bronchus. Most serious complication– perforation of the cyst into the free abdominal cavity. Symptoms of anaphylactic shock and widespread peritonitis occur. Perforation of a cyst into the free abdominal cavity significantly worsens the prognosis of the disease due to dissemination of the process.

Suppuration of an hydatid cyst is associated with the formation of a crack in the hydatid capsule, especially in the presence of communication with the bile ducts. Bacteria in bile serve as a source of infection. When an hydatid cyst suppurates, severe pain in the liver area, hepatomegaly, hyperthermia and other symptoms of severe purulent intoxication occur.

Alveolar echinococcosis in all cases accompanied by liver damage. For a long time, the invasion is asymptomatic. The leading symptom is hepatomegaly due to the development of a tumor-like node of exceptional, “wooden” density. Liver mobility is limited due to the development of perihepatitis. The spleen is enlarged in a third or half of patients. A frequent and persistent symptom is jaundice. When the process is far advanced, the functional tests liver.

For diagnosis of alveolar echinococcosis What matters is a long-standing liver “tumor” of extreme density, hypereosinophilia, liver scan and positive results allergy tests. The Katsoni reaction with alveolar antigen has the greatest diagnostic value.

Treatment of liver echinococcosis:

The purpose of the operation is the radical removal of the cyst along with the membranes and their contents without leaving scolex and blisters in the liver, abdominal or thoracic cavity. In most cases, the fibrous capsule is not removed. The scope of surgical interventions depends on the location, size, number and complications of cysts. In case of marginal localization of a cyst with calcification, an ideal echinococcectomy is performed along with a fibrous capsule according to A.V. Melnikov, possibly using a CO2 laser.

In case of multiple echinococcosis and with the marginal location of cysts, as well as giant cysts occupying the entire lobe, atypical or anatomical resection of the liver is performed. For single cysts, even giant ones, for cysts of both halves of the liver and for a suppurating cyst, the operation of choice is a one-stage closed echinococcectomy according to A. A. Bobrov and S. I. Spasokukotsky.

When the cyst is located subdiaphragmatically (segments 7-8) and there is a large residual cavity, capitonnage according to Delbe or cavity closure according to A.T. Pulatov is performed in combination with omentoplasty or plastic surgery with a diaphragm flap.

If a cyst breaks into the biliary tract, urgent surgical intervention is performed - choledochotomy with external drainage or closed echinococcectomy, choledochotomy with removal of membranes and cysts from biliary tract. The operation is completed with external drainage of the common bile duct, or the imposition of choledochoduodenostomy, or endoscopic papillosphincterotomy, transhepatic hepatocholangiostomy due to obstructive jaundice.

Urgent surgical intervention is also performed when a cyst breaks into the abdominal cavity, bronchus or pleural cavity. Closed or semi-closed echinococcectomy and, exclusively in difficult cases, open (marsupilization) echinococcectomy are performed.

In case of bile-bronchial fistula, the fistula is separated and the hole in the bronchus is sutured.

In case of multiple echinococcosis of the liver, the operation is performed before complications develop; first, complicated or giant cysts are removed, sometimes the operation is performed in 2-3 steps after 2 weeks - 3 months.

Mortality is 1-5%, long-term results are good, relapses are 2-25% and occur due to complete removal daughter blisters, leaving undetected cysts, contamination of abdominal and thoracic wounds with cyst contents, repeated invasions, technical errors.

Prevention of liver echinococcosis:

A set of veterinary medical measures for echinococcosis is aimed primarily at identifying and eradicating the source of invasion. In accordance with official recommendations we're talking about on reducing the number of guard service dogs, their registration, registration and destruction of stray animals.

Farm veterinary specialists carry out preventive deworming of service dogs every 45 days from December to April, every 30 days from May to November, and once a quarter for the rest. These measures should also be taken with regard to personal dogs. Deworming is carried out at special sites, where the excreted feces are collected in a metal container and neutralized: (boil for 10 - 15 minutes, pour in a 10% solution of bleach for 3 hours, the soil is treated with a 3% solution of carbation (4 liters per 1 m2 ).

To prevent infection of dogs, it is necessary to follow the rules for the slaughter of farm animals and ensure the destruction of affected organs, as well as to prevent dogs from accessing the territory of meat processing plants, slaughterhouses, and cattle burial grounds.

Measures to prevent infection of dogs also include such mandatory recommendations as: increasing the veterinary and sanitary level of farms; construction of disposal pits, cattle burial grounds; compliance with the rules for storing and transporting animal corpses; slaughter of animals only in appropriate places, etc.

Medical measures include identifying those infested by examining decreed groups (hunters, people who have contact with dogs, those involved in fur processing, manufacturing fur products, shepherds) and examination according to clinical indications; deworming and dispensary observation. Health education work is important.

Personal prevention of echinococcosis is to limit contact with dogs, children playing with them, wash your hands thoroughly after contact with animals, before eating, after working in the garden, playing in the yard, in the garden, picking mushrooms, not eating unwashed wild berries, not drinking unboiled water from natural reservoirs.

Which doctors should you contact if you have liver echinococcosis:

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Echinococcosis is a helminthiasis from the class of cestodoses, as a result of which an hydatid cyst appears in the lungs, kidneys, liver and other organs or tissues. Echinococcosis of the liver is caused by the introduction and maturation of tapeworm larvae in it.

In humans, infection mainly comes from unwashed hands. Infection from a dog can occur through its fur or tongue. Other animals can similarly be spontaneous transmitters of eggs and they also acquire them from contact with a sick dog.

There is also a possibility that a person can acquire echinococcosis by eating fruits, vegetables and wild berries that have not been washed or have not undergone initial processing. Water from natural lakes also serves as a source of contamination.

Echinococcal cysts can also appear in people working in sheep farming areas. It was shepherds, shepherds and those who came into contact with these people (members of their family) who sheared the sheep.

Signs of echinococcosis

Indicators of this disease are pain in the right hypochondrium, liver swelling, and nausea. From the onset of infection to the discovery of the first symptoms, several years, sometimes even decades, pass. Manifestations of echinococcosis are determined by the location, volume, rate of growth of the cyst and its effect on nearby organs and tissues.

In some cases, the malaise may pass without any symptoms, and it may be accidentally discovered during an ultrasound or x-ray. The disease often begins with the usual symptoms - prolonged low-grade fever, weight loss, general weakness, allergic reactions.

For the most part, hydatid cysts are initially located in the liver. The factor appears to be the properties of blood circulation: the outflow of blood from the intestines goes into the portal vein, the blood is cleansed by the liver. The entry of echinococcus into an organ is called liver echinococcosis.

Indicators of liver echinococcosis are:

How is an hydatid cyst of the liver eliminated?

Liver surgery is performed to completely remove the cyst with its membrane and contents, so that there is nothing in the organ itself, the abdominal and thoracic cavities. In case of deep location or serious damage, the membrane remains. The operation and its scope of work are determined by the size of the cyst and the problems it caused. If the marginal location of the cyst is detected, then it is removed along with the capsule. In such a surgical intervention, laser removal of an hydatid cyst can be used.

Types of operations

If there is multiple echinococcosis of the liver, large cysts, then its resection is done. If one huge cyst is detected, an operation according to Spasokukotsky or Bobrov is performed, which involves internal echinococcectomy.

If the cyst is located under the diaphragm, and a huge cavity appears as a result of surgery, then it is tightened using the Pulatov or Delbe method or covering the formed cavity with a piece of the diaphragm.

If a cyst breaks into the bile ducts, emergency surgery is performed. Remove walls and cysts from affected areas of the bile ducts. In such a situation, drainage of the bile ducts is inevitable.

If the cyst ruptures into the abdominal cavity, then urgent surgery is performed. During this process, cysts and capsules that are in the bronchi, abdominal cavity and pleural area are removed. Semi-closed and closed echinococcectomy is performed. In severe situations, open echinococcectomy is performed.

In case of mass echinococcus of the liver, it is important to perform surgical intervention before problems arise. Liver surgery can be performed in 2-3 processes with an interval of two weeks to three months.

Mortality with echinococcus ranges from 1 to 5% of infected people. Recurrences may also occur if the cyst has ruptured.

Prevention

Infection of domestic animals and humans is based on procedures performed by medical and veterinary services. Domestic and service dogs must be constantly examined for helminths, especially in unfavorable areas, treated for helminths, euthanized stray animals, and monitored meat in slaughterhouses.

What is necessary?

Regularly carry out hygiene for the population (dog breeders, livestock breeders, hunters and members of their families), keep dogs clean, constantly wash your hands after interacting with them, as well as before meals, prohibit children from contacting stray animals, wash vegetables and berries properly, drink only disinfected water.

Echinococcal cyst of the lung

Disease on early stages It manifests itself little and is detected during an X-ray examination of the lungs in the form of an oval silhouette with precise lines. The hemogram indicates eosinophilia.

The third stage of pulmonary echinococcosis has a serious severity of pathological development and a process of complications. Symptoms of compression of large vessels and mediastinal organs are observed, deformation of the chest is noted, shortness of breath and hemoptysis appear. When echinococci die, inflammation of the cyst occurs with special clinical symptoms empyema of the pleura or lung.

The opening of the cyst into the bronchial passage is accompanied by the discharge of a considerable amount of bright discharge with daughter blisters of echinococci streaked with blood. When the opened cyst suppurates, purulent-hemorrhagic sputum comes out, and manifestations of poisoning are also observed. The opening of the cyst into the cavity of the membrane provokes the appearance exudative pleurisy and anaphylactic shock. shows a cavity with a horizontal liquid surface, not very pronounced perifocal infiltration. Such infiltration is detected if echinococcal cysts suppurate.

Treatment

Surgical methods of therapy are used (remove the cyst from the cuticular capsule, remove the lung). The prognosis is quite serious; with a bilateral course and secondary echinococcosis, it is sad.

Echinococcosis of the kidney

Echinococcal today is found infrequently, mainly in agricultural areas. The disease is caused by the helminth Taenia echinococcus. Distributors of the causative agent of the disease are pets - dogs and cats. As a rule, one kidney is affected, in rare cases - two. Liver echinococcosis affects the population aged 20 to 40 years, especially women.

The helminth egg enters the kidney by lymphogenous or hematogenous means, most often into the cortical layer.

Therapy and prognosis

Treatment for the most part is organ-preserving and surgical. The most reliable and effective operation is an internal one-stage echinococcotomy. A nephrectomy is also done.

Prevention of echinococcosis requires sanitary and educational procedures to familiarize people with the threat of infection from domestic animals, executive sanitary and veterinary supervision of slaughterhouses.

After surgical therapy, the prognosis is positive.

Echinococcosis of the spleen

This disease is not easy to detect. Echinococcal cyst of the spleen is accompanied by disorders or constipation, minor dull pain, and allergic reactions. Palpation reveals an enlarged spleen. Large blisters may burst, often resulting in death from accompanying organ rupture.

The most in an effective way Treatment of splenic cysts is considered laparoscopic surgery. Echinococcal cysts can be operated on using several methods:

complete removal of the spleen;
opening the cyst and removing the contents from it, cleaning the cavity;
cutting out the affected area of the spleen;
removal of the splenic cyst with its wall and contents;
excision of the cyst shell.

Laparoscopic surgery for a splenic cyst is a common method of therapy, making it possible to completely remove the source of the disease. Removal of a splenic cyst is carried out using ultra-precise instruments and the insertion of a special camera. The duration of the surgical action is 1.5-2 hours. Then the pain remains for some period, but in a short period of time the patient makes a full recovery.

The prevalence of echinococcosis is quite low, but at the same time this disease is very dangerous. Infection occurs orally (ingestion of eggs or a mature segment, that is, the part of the worm’s body in which the eggs mature), most often due to the consumption of unwashed vegetables, fruits, wild berries, and contaminated food. Also, the causative agents of the disease enter the body through unwashed hands after contact with a sick dog or if they are contaminated with dog feces, wool of sheep, or goats. The source of infection is dogs, less often wolves, foxes, and jackals.

The latent period (from infection to diagnosis and initiation of treatment) of echinococcosis lasts from a couple of months to several years. The medical literature describes a case where he reached 75 years of age, but usually this is 5-20 years. One or several cysts ranging in size from 1-5 to 40 cm in diameter may form in the affected organ. The formation grows, pushing the tissues away and squeezing them, which can cause their atrophy and necrosis. The disease develops very slowly, causing mild symptoms, and takes a very long time to cure.

Most often, the disease affects the liver (54-84% of cases), lungs (15-20%), the central nervous system, less often the brain, spleen, cavities of tubular bones, kidneys, and pelvic organs. Echinococcosis causes the formation of a number of clinical syndromes:

If the liver is damaged, the patient feels pain in the upper abdomen, headache, loses weight. These manifestations are combined with aching pain in the right hypochondrium and heaviness. Echinococcosis often imitates the symptoms of tumors of different locations due to mechanical effects on the tissues of growing Finns. When the liver is damaged, they compress the bile ducts, causing jaundice, exhaustion, and less commonly, cirrhosis. This organ can also suffer from multilocular echinococcosis, which causes.

The symptoms of the disease and the intensity of its manifestation depend on the location of the echinococcus, the size of the bladder, the degree of damage to other tissues and organs, intoxication, and the presence or absence of a bacterial infection. In children, the disease develops faster due to the presence of very favorable conditions habitat and less resistance of the body.

A severe course of the disease is most often observed during pregnancy, with the formation of an associated disease, nutritional deficiency, or infection of persons who do not live in the area of the outbreak.

Diagnosis and treatment of liver echinococcosis

Blood is taken for research using serological methods, when specific antibodies produced by our immune system are detected in the patient’s blood serum. They are based on serological reactions: agglutination, precipitation, neutralization, with the participation of complement, using special antibodies and antigens. Most often, doctors recommend doing linked immunosorbent assay blood (ELISA), based on the last reaction. You also need to do clinical analysis this biomaterial. The development of the disease is indicated by a several-fold increase in the level of eosinophils (a subtype of leukocytes). Also, if liver echinococcosis is suspected, an ultrasound of internal organs, computed tomography, and, if necessary, magnetic resonance imaging are required. Examination of internal organs using an endoscope and taking a biopsy (a small piece of tissue) should not be carried out.

When determining the cause of the patient’s discomfort, the doctor must gradually eliminate incorrect options, correlating various diseases with their characteristic symptoms - make a differential diagnosis. With echinococcosis they are as follows: tumors, cysticercosis (helminthiasis caused by larvae pork tapeworm), tuberculosis, allergic dermatitis.

As an alternative, mebendazole (0.5 g -25-30 mg/kg/day in 3-4 doses for 15-24 months) can be used. Sometimes the patient requires several years of continuous medication. Also, therapy for liver echinococcosis is supplemented antihistamines to relieve allergies, glucocorticosteroids to disrupt the encapsulation process of echinococcus. The dynamics of treatment are monitored through blood tests (general, ELISA, biochemical), ultrasound, and the disappearance of symptoms is monitored. In rare cases, spontaneous recovery is possible if the invasive material is released from the body, for example, through vomit.

In approximately 30% of cases, complications may arise in the process of fighting the disease: suppuration of the bladder due to the addition of a bacterial infection, inflammation of the bile ducts, breakthrough into the abdominal cavity, rupture of pulmonary echinococcus, embolism (after penetration into the vessels of daughter blisters, parts tapeworm), the occurrence of cavities of decay of alveolar echinococcus, lung abscess, accumulation of pus in the pleura. Relapses (return of the disease) are recorded in 25% of patients. To reduce the likelihood of recurrence of the disease, anti-relapse treatment is mandatory after surgery.

Prevention of liver echinococcosis involves careful adherence to personal hygiene rules. You should always wash your hands with soap after contact with dogs, use only hot, washed hands. running water vegetables, fruits, berries. Those recovered from echinococcosis remain in the dispensary for 5 years, even if there are no suspicious symptoms. Once every six months, the patient must undergo a follow-up examination (ultrasound, R-graphy, serological methods, specialist consultation, depending on the location of the cyst: pulmonologist, neurologist). Deregistration is possible only after receiving 3-4 times negative serological blood test results within 3-4 years.

Liver echinococcosis is considered one of the life-threatening diseases caused by worms. Its causative agent is the helminths Echinococcus granulosus and Alveococcus multilocularis, the smallest of the tapeworms. A person may not be aware of infection for many years, during which another form of life matures in his body.

The length of a sexually mature individual, the so-called cestode, is 0.3–0.9 mm, width - about 0.5 mm. Upon careful examination, they can be seen with the naked eye. The head (scolex) of the tapeworm is equipped with a proboscis, several suckers and 30–50 hooks, supplemented by a neck, two pairs of segments, one of which is a uterus containing from 200 to 800 eggs.

Worm eggs enter the body through dirty hands, contaminated food, and water. You can become infected through active interaction with pets. Dogs carry eggs and adult cestodes on the tongue or in the fur.

The oncosphere forms a single-chamber vesical capsule filled with liquid, microscopic at first, but growing slowly and steadily.

The size of the cyst varies from 1 to 10 cm in the first 2–3 years of development, and with long-term growth it can increase to 40 cm in diameter and accumulate several liters of fluid.

Most often, the right large lobe of the liver is affected, and the development of a single hydatid and multiple cysts is likely.

The inner - germinative - membrane of the hydatid cyst of the liver has complex structure, actively functions and produces new scolex and embryos - oncospheres, freely suspended in a liquid medium or attached to the walls. The outer dense shell consists of a chitinous layer, similar to the armor tissue of insects, and ensures the hardness and impermeability of the cyst. The growing capsule causes reactive necrotic changes in cells at the site of contact with the parenchyma and subsequent enveloping of the chitinous membrane with fibrous tissue. Large hydatids form within themselves daughter bubbles with a similar structure, which, in turn, form grandchild bubbles.

Liver echinococcosis has a mechanical and sensitizing pathological effect.

First Clinical signs diseases appear as the bladder grows - increasing in size, it puts pressure on the surrounding liver tissue, pushing them apart. When echinococcosis is localized in right lobe the patient experiences a feeling of fullness, tightness or heaviness, periodic dull pain in the right side. Physical sensations are similar to manifestations of cholecystitis and cholelithiasis. The left-sided location of the cyst causes dyspeptic symptoms - belching, stomach and intestinal cramps, heartburn. Occasionally, allergic manifestations in the form of minor skin itching, rashes that do not cause alarm due to their mild severity.

Complications

The steady growth of the cyst leads to compression of the bile ducts, impaired circulation in the parenchyma, and atrophic changes in tissue. For late stages The disease is characterized by the development of obstructive jaundice. A bubble localized in the lower part of the liver disrupts the patency of the vena cava, leading to ascites and dilation of the veins of the anterior wall of the abdominal cavity.

Infection of the gallbladder, ducts, and blood vessels of the liver is fraught with anaphylactic shock. The patient is at risk of death from a sudden fall blood pressure and hypoxia.

Another complication is suppuration of the contents of the cyst, which affects every 5th case of the disease. Perennial hydatids are infected by microbes penetrating through microcracks in their walls. The source is presumably bile. Bacteria cause inflammation of the internal contents of the bladder. The process may be asymptomatic, but an acute clinical picture is also likely: high temperature up to 40°C and above, severe abdominal pain, profuse sweating, trembling, weakness, signs of intoxication.

Alveolar echinococcosis

In contrast to the hydatid form, the alveolar form forms a multi-chamber system of bubbles from 0.5 to 4 cm, which do not have a dense shell and are closely connected to each other. The growth of new cysts occurs exogenously, with the replacement of healthy liver cells by pathological ones, similar to a malignant tumor. The resulting fibrous tissue tightly compresses the alveoli, disrupting their shape and giving them a knotty, hard structure. Inside the alveoli are filled with a semi-liquid yellowish substance with scolex of echinococcus.

The latent period of progression is replaced by manifest forms of the disease several years after infection. Characteristically, there are signs of liver damage: discomfort, pain, heaviness in the right side, pain in the epigastric region, indigestion.

Diagnostics

A complete medical history is collected, taking into account the patient’s place of stay or residence in epidemically unfavorable areas, the type of occupation is clarified - specialists in agricultural enterprises, people involved in breeding and keeping dogs, and those with livestock are at increased risk of contracting echinococcosis.

Clinical symptoms of the disease are nonspecific, inherent in a number of liver and gastric pathologies and serve as indirect signs of the disease.

The presence of echinococcosis can be detected during an external examination of the liver: large hydatides and alveolar formations can be felt in the soft parenchyma if they are close to the edges of the organ. To differentiate from other types of cystic growths and tumors, additional diagnostics are carried out.

Instrumental methods:

Ultrasound - it can be used to identify uncomplicated and complicated forms of cysts, wall thickness, signs of necrosis and calcification;
magnetic resonance imaging - allows you to view the contours and structure of the formation, visualize daughter blisters and other elements suspended in the cyst fluid.

When diagnosing echinococcosis, laparoscopy is not used due to the risk of damage to the walls of the cyst.

Serological studies are based on the detection specific antibodies to echinococcus in blood serum. Are used:

ELISA (enzyme-linked immunosorbent assay);
RNHA (indirect hemagglutization reaction).

Additionally, echinococcosis is confirmed by the results of general and biochemical tests: rapid ESR, leukocytosis, eosinophilia, high level of direct bilirubin, ALT and AST.

Treatment and prevention

There are no other methods to completely get rid of liver echinococcus, except surgery.

Alveolar echinococcosis is curable only at the stage preceding metastasis, if there is no germination to other organs. The operation is performed by resection of the affected tissue along with the node.

In advanced stages, palliative treatment is used, aimed at alleviating the symptoms of the process and maximizing life extension.

Anti-relapse treatment involves 2-3 courses of 28 days. Inoperable cases of the disease - 10 courses.

Additionally, antihistamines and hepatoprotectors are prescribed.

Compliance with personal hygiene requirements can protect against infection with echinococcus: basic hand washing, caution when choosing sources of drinking water.

It is necessary to promptly check domestic dogs for the presence of helminthic infestations, prevent their contact with stray animals.

Veterinary control authorities and Rospotrebnadzor are obliged to monitor the proper disposal of corpses of wild and domestic animals, slaughterhouse waste, and examine persons at risk of infection due to the characteristics of their profession - hunters, shepherds, agricultural workers.