Echinococcosis of the liver

Echinococcosis of the liver among parasitic diseases of the liver in its frequency of occurrence and practical significance is in the first place. There are two types of liver lesions Echinococcus: single chamber (heatedly) and alveolar (multichamber) echinococcosis of the liver.
The prevalence of echinococcosis is observed mainly in Eastern and southern countries with subtropical climates. In the Nordic countries Echinococcus describes relatively rare; the only exception is Iceland, where echinococcosis is a very common disease. Human liver among internal organs is affected most often and is more than 61% of all localizations Echinococcus.
Pathological anatomy. The structure if Echinococcus cyst is represented in the following form: the outer layer it consists of fibrous tissue inner layer is a chitinous shell, the contents of the cyst - transparent colorless liquid containing koleksi. Float in the liquid different sizes child cysts.
If Echinococcus cyst liver grows very slowly and in small sizes it does not show itself.
Symptomatology. Complaints of the patient and objective clinical signs usually appear when zooming if Echinococcus cyst to a certain value. Then any pressure on the surrounding liver tissue, increase in liver size, stretching glassonby capsules and some progress in the functional samples. In such cases, the size if Echinococcus cyst should be no less of an adult's fist. Complaints of the patient are reduced to a feeling of heaviness in the right upper abdomen and the lower half of the thorax. With further growth of cysts appear dull pain in the liver caused by the stretching glassonby capsules. Then there are symptoms, the mechanical pressure of the neighbouring organs: stomach, duodenum, transverse colon intestine, bile ducts and other
From the objective of the research data of the patient in the first place is the increase of the size of the liver, with the smooth surface of her and painless region. Sometimes probing the cysts in the case of the last to palpation region. If the cyst is large size is zadavina parts of the liver, the diaphragm is a dome rises, and percussion detects the expansion of the upper limits of the liver in the back, front and sides.
For specification of the diagnosis is set to x-ray examination using pneumoperitoneum, tomography, scanning the liver and intradermal reaction of Casoni, characterized by extreme ease of use. It is believed to be in the presence of Echinococcus makes 80-90% of positive results. It is recommended to always have a relatively freshly if Echinococcus standard liquid for the reaction of Casoni. Some value in the diagnosis of hydatid is the increase in the number of eosinophils in the peripheral blood from . 5 to 20%.
The differential diagnosis should be borne in mind alveolar echinococcosis, separatornyi cysts of the liver, swelling of the liver, cirrhosis of the liver, etc.
Treatment of echinococcosis of the liver currently only surgical. Now is the spread of private method of surgical treatment. It lies in the opening cyst cavity, removing its contents and chitinous shell, wiping the cyst wall swab dipped in 50% formalin solution, and stitching tightly cut cysts. In the future it is filled cyst cavity with scar tissue. Operation is simple in theory, it is technically easy, non-traumatic, effective, immediate and distant results. Patients after a successful operation of hepatic echinococcosis finally recover and practically able to work, including the physical.
Complications. When festering if Echinococcus cyst surgery is used similar to the above, with the addition of tamponade cavity cysts.
More rare complications associated with growth if Echinococcus cyst liver include rupture of a cyst and the outpouring of its contents into the abdominal cavity. This is accompanied by a sharply expressed allergic reaction and contamination of the abdominal cavity.
Among the complications of hepatic echinococcosis should mention jaundice caused by compression of the extrahepatic bile ducts and breakthrough if Echinococcus cyst in the bile ducts. The nature of these complications can be established only if recognized echinococcosis.
When echinococcosis of the liver may occur diffuse lesions her with outcome to cirrhosis (N. I. Tobolska and M. N. Alekseeva, 1965).
In case of compression extrahepatic bile duct-chamber if Echinococcus cyst compression is eliminated when emptying the contents of the cyst. When growing in the alveolar ducts Echinococcus is necessary to remove the obstacles resection of the bile duct, and when impracticability of such a plan operations - creating bypass anastomosis of the biliary tract.
In the diagnosis of localized lesions of the biliary ducts subsidiary importance splenoportography and cholangiography.