Echinococcal cyst. Liver echinococcosis: treatment, causes, symptoms, prevention. Damage to the choleretic gland by echinococcosis

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, 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 an hydatid cyst of the liver has a 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. Hydatids large sizes They form daughter bubbles within themselves with a similar structure, which, in turn, are grandson 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 the right lobe, the patient experiences a feeling of fullness, tightness or heaviness, periodic dull pain on 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. Rarely likely allergic manifestations in the form of slight 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, atrophic changes fabrics. 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 sharp 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 possible: heat up to 40°C and above, sharp pains in a stomach, 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 replacement healthy cells liver pathological, like 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, and the type of occupation is determined - increased risk Specialists of agricultural enterprises, people involved in breeding and keeping dogs, and those who have livestock are exposed to echinococcosis.

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

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 of 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 direct bilirubin, AlAt and AsAt.

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.

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

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 and 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.

• Causes of echinococcosis
• Symptoms of echinococcal liver cyst
• Possible complications similar disease
• Liver echinococcosis: treatment and prevention

Echinococcosis of the liver is a helminthiasis in humans, which is caused by the introduction and development of the larva of the worm Echinococcus granulosus in the liver.

Causes of echinococcosis

The causative agent of this disease is the larval stage of the tapeworm echinococcus. Cysts of this type are small formations in the form of bubbles that disperse on the membrane of the embryo and are connected to it by a thin stalk. The bubbles are filled with liquid, which acts as a nutritional medium to protect the capsules and scolex.

Freely suspended or detached scolex, as well as capsules called hydatid sand, can be observed in the fluid.

Echinococcal cysts that form in animals most often do not contain capsules. They are called acephalocysts. This form does not occur in humans.

The routes of infection for transitional owners may be different. Herbivores can become infected by eating eggs, grass, hay or water. Pigs become infected by eating dog feces. Main role Contact with infected dogs, which may have Echinococcus eggs on their fur and tongue, plays a role in infecting people.

A person can also become infected by eating dirty vegetables and fruits. In some cases, people become infected from wild animals during hunting. Natural bodies of water can also cause the disease.

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Symptoms of echinococcal liver cyst

For a long period there may be no clinical symptoms of the disease, but the person will feel completely healthy. The disease can manifest itself only if the hydatid reaches an impressive size. IN in this case dull, aching and continuous spasms may appear in the right hypochondrium and lower part chest. If there is a cyst of impressive size, then during the examination it will be possible to identify a bulging of the anterior abdominal wall in the area of ​​the right hypochondrium. It will also be possible to detect an upward expansion of the borders of the liver. In this way, a rounded tumor can be detected. If the cyst is located deep in the parenchyma of the infected organ, then hepatomegaly can be observed.

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Possible complications of this disease

Symptoms of the disease may change if large cysts compress nearby organs. The following complications may occur:

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Liver echinococcosis: treatment and prevention

You should know that today there is no medicine that has positive impact for hydatid cyst of the liver.

The high incidence of significant complications of such a disease indicates the need for surgical treatment of the pest, while its size does not matter.

If the cyst is located subdiaphragmatically, it will be necessary to perform Delbe capitonnage.

Immediate surgery will also need to be performed in the event of a cyst breakthrough in abdominal cavity. It is imperative to perform a closed echinococcectomy.

In case of multiple diseases, surgery is performed before complications develop. The first step is to remove complicated cysts; in some cases, several operations may be necessary.

Treatment of liver echinococcosis is complex process. It is not recommended to delay a visit to the doctor if symptoms characteristic of such a disease have been detected.

Echinococcosis of the liver develops as a result of damage to the organ by the larvae of tapeworms Echinococcus. Most often, helminthiasis occurs in rural areas; the risk group includes farm workers and hunters. The disease is dangerous, against its background severe pathologies develop, with running forms requires a liver transplant.

The causative agent of echinococcosis

What is Echinococcus? This is a tapeworm no larger than 5 mm in size, up to 0.8 mm wide, present in stool, study appearance and the structure can be seen in the photo below.

Liver damage

Echinococcus affects various organs human - liver, lungs, less often the larvae penetrate the tissues of the kidneys, brain and spinal cord.

How do echinococci develop in the human body:

1. Human infection most often occurs from dogs; the larvae enter the body orally through unwashed hands, through the consumption of poorly cooked meat, dirty berries, vegetables, and herbs.
2. Immediately after infection, the larvae enter the intestines, disrupt the organ’s mucosa, spread throughout the body through the bloodstream, and enter the liver, where they continue to develop.
3. In the human body, echinococcus is in the larval stage - the larva is enclosed in a capsule, inside which there is liquid and a large number of worm embryos. The shell of the bladder has 2 walls; new larvae are constantly formed in the inner part, which leads to the growth of the capsule and cysts are formed.

The danger of echinococcal cysts is their constant growth, they begin to put pressure on the liver, which prevents the organ from performing its functions normally.

Symptoms of liver echinococcosis

Clinical picture

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When infected with echinococci, helminthiasis develops slowly; for a long time a person may not even suspect that he is infected.

Not all doctors can diagnose the disease in a timely manner; they often confuse it with other pathologies and prescribe the wrong treatment.

Only after a long period of time will an ultrasound show cysts that are located in the internal organs.

Signs of infection with echinococcus:

• on initial stage– rare pain in the area of ​​the right hypochondrium;
• As the disease progresses, signs of liver dysfunction appear - loss of appetite, loss of body weight, allergic reactions often appear even to familiar medications, pain in the liver area intensifies and is chronic;
• after fried and fatty foods, a person suffers from attacks of nausea and vomiting;
• If treatment is not started in time, the cyst will rupture, the larvae and pus will spread with the blood throughout the body, which will cause serious complications.

Advanced stages of echinococcosis occur against a background of severe weakness, performance decreases, and the temperature may rise for several days without other signs of a cold. A person infected with worm larvae suffers from constant migraines, itchy skin, and rashes on the body.

The rupture of an hydatid cyst is indicated by severe swelling, allergies, skin ulcers, severe itching. Additionally, shortness of breath appears, coughing, which indicates the penetration of larvae into the respiratory system.

Methods for diagnosing the disease

An external examination does not always allow the doctor to detect the presence of echinococci in the body; a specialist may pay attention to an enlarged liver; when palpating the organ, the patient complains of severe pain. But these signs are indirect and do not allow an accurate diagnosis.

In the treatment of echinococcosis they use A complex approach, which is aimed at removing cysts, eliminating larvae, normalizing liver function and digestive system, strengthening protective forces body.

Without proper treatment, Echinococcus larvae will constantly poison the body with toxic substances, and irreversible consequences will begin to develop against the background of severe intoxication. With constant mechanical pressure on the liver, tissue in the organ will die, which will lead to a complete loss of function.

Conservative treatment

Main types medicines for the treatment of echinococcosis:

Often found in people. According to modern data, echinococcosis is unevenly distributed around the 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?

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 possible unwanted adverse reactions, associated with a 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 in right hypochondrium, also after meals 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.

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 only general symptoms and signs of liver damage, then now there will be serious violations work from other organs and systems. The most common complications may be:

1. Cyst suppuration with the formation of purulent contents inside it. If an abscess ruptures, pus may enter the abdominal cavity with the development of peritonitis (acute purulent inflammation peritoneum - the lining of the abdominal organs). When a cyst breaks through chest cavity inflammation of the membranes of the lungs develops - purulent pleurisy.
2. 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. active substances, which contribute to the formation of tissue edema, the appearance varying intensity skin rashes, narrowing of the lumen respiratory tract 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.
3. A large cyst can press on surrounding tissue, including the portal vein and intrahepatic bile ducts. The following symptoms may occur:

• When the intrahepatic bile ducts are compressed, 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, and then enters the gallbladder, then into the 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 a greenish tint, constantly feels itching of the skin, and the urine becomes “colored” strong tea or beer."
• When closing the lumen portal vein there is an increase in blood pressure in 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. A clinical picture of disturbance of these organs is observed. 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 increased blood pressure 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 caused by insufficient blood flow 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. Frequent loss of consciousness, pain in the heart, impaired kidney function and many other disorders associated with insufficient blood supply to organs and systems appear.

Symptoms of pulmonary echinococcosis

On early stage lung lesions There are symptoms such as:
Dry hacking cough, which becomes specific over time bad smell and become wet 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 diseases, 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

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. At the 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

Second group laboratory tests involves 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 x-ray method, revealing 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 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 location cystic formation, in order to avoid complications associated with damage to deep vessels and bile ducts, take a different operational approach. 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. Carried out by removing parts of the most large 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

Prevention of echinococcosis

1. 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

1. Timely washing of hands with soap after the above steps will prevent infection from entering the body.
2. 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.
3. Careful heat treatment of meat is also very important because it may contain echinococcus larvae.
4. 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?

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.

• 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.

• drugs that improve blood circulation in the brain: Actovegin, Cerebrolysin, Piracetam and so on;
• physiotherapy aimed at recovery 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 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?

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

Another question is when the disease is detected, because echinococcal cysts grow slowly, over years, and sometimes decades, while symptoms of the disease are often absent, so echinococcosis is more often detected in children adolescence and young people. 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 when serological studies blood if you suspect other helminthic infestations(giardiasis, ascariasis, toxocariasis and others). And the standard tablet also includes tests for echinococcus. If antibodies to echinococci are detected, additional instrumental studies liver, lungs, brain and other organs.

Signs and symptoms of echinococcosis in children:

• poor appetite resulting in weight loss;
• weakness, learning retardation, impaired concentration;
• subjective sign: grinding teeth in sleep;
• 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, the general condition sharply worsens, body temperature rises, severe shortness of breath, weakness, and possible hemoptysis appear. severe cases with alveococcosis of the liver, liver failure develops.

• 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.

What does echinococcus look like (photo)?

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. X-ray picture very similar to the picture of infiltrative pulmonary tuberculosis with destruction of lung tissue (cavity). Without additional research it is impossible to figure it out. Echinococcus is often discovered during surgery for pulmonary tuberculosis.

Slice computed tomography liver with echinococcal 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 large sizes. 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 lick the area intensively anus, rub 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.

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 (a special diagnostic test for detecting antibodies to echinococcus).

The liver is the most common site of development of echinococcus in humans. The liver accounts for about 70%. Echinococcal germs are spread throughout the body mainly through the vein system (85%), less often through arterial system(15%), which determines the frequency of damage to one or another organ.

The egg of Taenia echinococcus, a small flatworm that lives in the intestines of a dog, gets into gastrointestinal tract human, turns into a six-hooked embryo, which penetrates through the portal vein into the liver and there, lingering in the capillaries, goes through the vesicular stage of its life. An echinococcal cyst (echinococcus hydatidosus) is formed.

The wall of the cyst consists of two layers: the outer layer - xitin, and the inner layer - germinal layer, consisting of cells with nuclei. In the germinal layer, germinal capsules develop, then separate and fall into the cyst cavity, representing microscopic cysts with a proboscis invaginated into the cavity, armed with six hooks (endogenous development).

The developed hydatid cyst contains clear liquid, similar to distilled water. This liquid contains salts, succinic acid, toxins, but does not include protein. White grains float in the liquid - separated germ capsules, as well as free hooks. About 90% of liver hydatid cysts contain only fluid with the described impurity, which is called “hydatid sand.” 1 ml of echinococcal sand can contain up to 400,000 scolex.

The remaining 10% of cysts, in addition to “sand” in the liquid, contain larger blisters that completely replicate the structure of the mother’s bladder, the so-called daughter blisters, which developed from the germinal capsules.

Daughter bladders, embryonic capsules and even scolex have the ability to independently further develop to a mature state: without passing through the worm stage in the intermediate host. This explains the development of secondary echinococcosis when the contents of an hydatid cyst enter the abdominal cavity or onto the wound surface.

In the liver, most often in the right lobe, usually one cyst develops, and very slowly, over several years. Only in 8% of cases there are two or more cysts.

Liver echinococcosis is most often found in pastoral areas.

Liver echinococcosis: symptoms

IN initial period development of liver echinococcus does not manifest itself clinically, except for intermittent symptoms - an occasional nettle rash, pain in the right shoulder. But, having reached a certain size, echinococcus begins to attract attention. Symptoms of liver echinococcosis vary significantly depending on the location of the cyst in the liver. Most often, the cyst grows, protruding forward. In this case, it forms a tumor emanating from the enlarged liver.

The tumor has the shape of a segment of a ball and is located in the right hypochondrium or epigastric region. The tumor is tense, in in rare cases gives fluctuation, is painless, moves with breathing. A dead echinococcal bladder loses tension. Sometimes echinococcus gives a symptom of “hydatid trembling”, which consists in the fact that the hand placed on the tumor, when tapping with the other hand, feels a trembling in the depths.

The phenomenon of “trembling hydatid” can also be perceived by the ear through a stethoscope. The symptom of trembling is not specific, characteristic exclusively of echinococcus, but only indicates a certain degree of tension in the cyst. Echinococcal cysts protruding onto the lower surface of the liver sometimes compress the large bile ducts and cause jaundice. Compression of the portal vein leads to ascites, compression of the inferior vena cava leads to edema of the lower extremities.

Hydatid cysts developing in upper section liver, grow towards the diaphragm, lift it high, compress the lung and give symptoms similar to those of exudative pleurisy.

Central cysts give a picture of a general enlargement of the liver.

Rupture of an hydatid cyst

Rupture of an echinococcal cyst is observed quite often, according to Nadezhdin, in 22% of cases, and occurs independently or in connection with injury. The cyst usually opens into the abdominal cavity, where the contents are poured out, sometimes with an admixture of bile, which can be septic. IN the latter case peritonitis develops.

Most of the fluid flows down the lateral peritoneal canal into the right iliac region and into the pelvis, a smaller part spreads throughout the rest of the abdominal cavity. Rapid absorption of echinococcal fluid with the toxins it contains causes anaphylactic shock different strengths, expressed in vomiting, diarrhea, nettle rash and a drop in cardiac activity. Sometimes shock ends in the death of the patient.

A ruptured hydatid cyst is rarely cured completely. This is usually followed by secondary echinococcosis of the peritoneum. Scolexes, germinal capsules and daughter bladders that enter the abdominal cavity develop into multiple, often large hydatid cysts. Most of them are located in the right half of the abdomen. Very rarely, an echinococcal cyst opens into the large bile ducts, into the pleural cavity, bronchus, intestine, and outward.

Suppuration of an hydatid cyst is quite common and usually occurs in connection with influenza, abdominal or typhus. At anaerobic infection Gas forms in the abscess cavity. Clinical symptoms of suppuration: pain, tumor enlargement, fever, leukocytosis, rapid deterioration of general condition. Sometimes the suppurative process is sluggish, the symptoms are mild and suppuration is unexpected during surgery.

Liver echinococcosis: diagnosis

Recognition of superficial liver echinococcus cysts is relatively easy, while deep ones are often difficult. A test puncture is unacceptable, since the contents of the echinococcal bladder, once in the abdominal or pleural cavity, can cause secondary echinococcosis or infection of these cavities. When diagnosing liver echinococcosis, biological reactions play an important role.

X-ray examination makes it possible to judge the shape and contours of the liver, see deposits of calcareous salts, sometimes a rounded shadow in the center of the liver, and the high position of the diaphragm. Fluoroscopy with a stomach filled with a contrast mass often makes it possible to detect echinococcal cysts growing downwards.

Suppurating hydatid cysts can be mistaken for a liver abscess and vice versa. A breakthrough in the large bile ducts is usually mistaken for a stone blockage. The prognosis for liver echinococcosis is serious, since self-healing is rare and is usually followed by progressive growth, rupture or suppuration.

Liver echinococcosis: treatment

Suppurating echinococcus is usually removed in two steps, however, in case of a sluggish, non-temperature infection, a one-step method is also allowed, and the wound is opened open. Attempts to suture a surgical wound with festering echinococcus tightly, due to the weak virulence of the infection, were also often crowned with success.

To the front and lower cysts go by laparotomy, to the upper ones - through chest wall, transpleural. The fibrous capsule often contains fairly large blood and bile vessels. In this regard, in the postoperative period, bile leakage and sometimes bleeding from the wound are often observed.

The rationale is the possibility of not only endogenous (into the cavity of the bladder), but also exogenous (in the gap between the chitinous membrane and the fibrous capsule) growth of embryos. Unfortunately, the separation of any significant fibrous capsule from the liver tissue is accompanied by profuse, sometimes fatal bleeding, and exogenous reproduction of echinococcus in humans is rare.

Therefore, this method is used only for small or pedunculated cysts, partly for calcified cyst walls. Mortality after surgery for liver echinococcosis is about 7%, and according to some authors, even higher.

Alveolar echinococcosis of the liver

Alveolar echinococcus (echinococcus alveolaris), in contrast to cystic echinococcus, is a cluster of many small echinococcal cysts located not in the cavity of the maternal membrane, abundantly filled with fluid, but directly among dense fibrous tissue, strongly compressed by it and therefore losing its regular round shape. The cysts contain a gray-yellow gelatinous mass, echinococcus hooks and heads.

Clinically, alveolar echinococcus is a dense, irregular shape, diffuse, lumpy, painless, slowly growing tumor. The disease is accompanied by exhaustion, often jaundice, and sometimes ascites. The prediction is bad.

The diagnosis is complicated by the clinical similarity of the disease to cancer, hypertrophic cirrhosis and gumma of the liver. The Cazzoni reaction is obtained only with alveolar antigen, but not with the fluid of cystic echinococcus. Eosinophilia is often increased.

Treatment consists of a wedge-shaped excision of the affected area of ​​the liver, which is very rarely feasible, since it is possible only in the very early period of the disease, when the disease is detected only by chance.