HEPATIC AND INTESTINAL FLUKE Flashcards
what are the 5 hepatic flukes
Fasciola
Fasciola
Clonorchis sinensis
Opisthorcis
Opisthorcis
what are the 5 hepatic flukes
Fasciola hepatica
Fasciola gigantica
Clonorchis sinensis
Opisthorcis felineus
Opisthorcis viverrini
fasciola ______ is bigger than fasciola hepatica
fasciola gigantica
fasciola is called ________, adult worms are found in ____________
liver flukes
bile ducts
Sheep liver fluke (SHEEPATICA)
tEmpErate liver fluke (too many letter E’s)
fasciola hepatica
- Giant liver fluke
Tropical liver fluke
Fasciola gigantica
Unique feature of adult worms are presence of __________
Cephalic cone
Fasciola hepatica is smaller than __________ and it has a__________
fasciola gigantica
prominent shoulder
cephalic cone , 2 shoulders converging margins, smaller in size
fasciola hepatica
Less prominent in shoulders, parallel margins, larger in size
fasciola gigantica
Fasciola adult
* Intestine is ________
Testes are ___________
Ovary is __________
Vitellaria are _________
Fasciola adult
* Intestine is branched
* Testes are branched
Ovary is branched
* Vitellaria are extending up to posterior end
⚫ (+) Cephalic cone and shoulder (unique characteristic)
large ovoid, operculated, yellowis-brown, unembryonated
fasciola hepatica
Unembryonated when laid in the biliary tract and are evacuated with the feces
Embryonates in water to later release miracidium
fasciola hepatica
large ovoid, operculated, yellowis-brown, unembryonated
fasciola hepatica
Both are yellowish brown
* Both are ovoid
* Both operculated
* But this egg has thickened posterior end = _________
Paragonimus westermani
_______and ______ ova are both found in the stool.
Paragonimus and Fasciola
large ovoid, operculated, yellowis-brown, unembryonated
fasciola hepatica
_______and ______ ova are both found in the stool.
Paragonimus and Fasciola
Both are yellowish brown
* Both are ovoid
* Both operculated
* But this egg has thickened posterior end = _________
Paragonimus westermani
1st and 2nd intermediate host of fasciola hepatica
Fasciola hepatics
1st Intermediate host: Snail of the Genus Lymnaea
2nd Intermediate host: Aquatic vegetations/ water plants
⚫ Ipomea obscura (kangkong)
⚫ Nasturtium officinale (water cress)
large ovoid, operculated, yellowis-brown, unembryonated
fasciola hepatica
where can we get fasciola hepatica
dishes with raw water plant
_________ from the intestine will migrate through the intestinal wall then into the _____________of the liver parenchyma/tissue then into the ______ then to the ________
Metacercaria
Glisson’s capsule
liver then bile duct
Fascioliasis
* Acute or invasive phase
* The acute phase is also referred to as the
(5)
Fascioliasis
* Acute or invasive phase
* The acute phase is also referred to as the
(1) migratory phase
(2) invasive phase,
(3) hepatic phase,
(4) parenchymal phase
(5) larval phase.
Fascioliasis
* Human ingest the __________ encysted in the raw water plant.
* These Immature larval flukes migrate through the intestinal wall, the peritoneal cavity, the liver capsule, and hepatic tissue and, ultimately, to the bile ducts.
acute or invasive
Fascioliasis
metacercaria
Fascioliasis
* Acute or invasive phase
Triad:(3)
High fever - infection!
* Hepatomegaly - inflammation of the liver
* Marked eosinophilia - migrating parasites
_________- infection!
high fever
*___________- inflammation of the liver
hepatomegaly
_____________- migrating parasites
- Marked eosinophilia
Fascioliasis
Chronic or latent phase
Asymptomatic and corresponds to the period when the parasite has reached the ________
_____________________
* In some cases, the walls of bile duct may be eroded allowing the worms to re-enter the liver parenchyma and cause large abscess
bile duct
- If severe, adult worm causes infection), inflammation and fibrosis obstruction
What are the three halzoun symptoms
Picking throat sensation
coughing
sneezing
PCS
________________ is popular food presentation in lebanon and other countries of eastern mediterranean region
Raw ovine liver
Raw ovine liver is popular in what country ?
Lebanon
- Due to ingestion of infected liver where livers of sheep and goats are eaten raw
halzoun (pharyngeal fasciolliasis)
we can get halzoun symptoms from ?
ingestion of raw liver with infected larvae
- Adult worm temporary lodged in the pharyngeal mucosa causing edematous congestion of the soft palate, pharynx, larynx, nasal fossae and Eustachean tube
Dyspnea, dysphagia, deafness (eustachian tube), occasionally asphyxiation
halzoun
_________- infection!
high fever
________________ is popular food presentation in lebanon and other countries of eastern mediterranean region
Raw ovine liver
_________- infection!
high fever
____________ are infrequent but can occur in the peritoneal cavity, intestinal wall, lungs, subcutaneous tissue, and very rarely in other locations such as eye and brain.
- VERY RARE!!
Ectopic infection
________________ is popular food presentation in lebanon and other countries of eastern mediterranean region
Raw ovine liver
large ovoid, operculated, yellowis-brown, unembryonated
fasciola hepatica
large ovoid, operculated, yellowis-brown, unembryonated
fasciola hepatica
____________ are infrequent but can occur in the peritoneal cavity, intestinal wall, lungs, subcutaneous tissue, and very rarely in other locations such as eye and brain.
- VERY RARE!!
Ectopic infection
- High cases in countries which raises _______
cattles and water
buffaloes
fasciola gigantica
fasciola gigantica common name
giant liver fluke
tropical liver fluke
Fasciola gigantica
* NOTE: Everything in Fasciola gigantica is bigger than that of Fasciola hepatica EXCEPT for the ____________
shoulder
- Adult worm is larger
Larger ventral sucker - More branched intestine
Branches of ovary are longer and more numerous
Highly branched testes - Larger eggs
Fasciola gigantica
Treatment and Prevention (fasciola gigantica)
Treatment
_____________
* Prevention
____________
Treatment and Prevention
Treatment
Triclabendazole is the drug of choice
* Biothionol
* Prevention
Washing or cooking of vegetables
* Boiling of drinking water
Elimination of the snail hosts
Chemotherapy
Clonorchis
Intestine is ___________
* Testes are _______
Ovary is __________
Vittelaria is ____________
Clonorchis
* Intestine is unbranched
* Testes are branched
Ovary is lobed
* Vitellaria is only in the middle third of the body
* Chinese liver fluke
* 10-25mm long x 3-5mm wide
clonorchis sinensis common name is ________
chinese liver fluke
Opisthorchis
Intestine is ____________
Testes are _________
Ovary is __________
Vitelaria are _____________
Opisthorchis
* Intestine is unbranched
* Testes are LOBED
Ovary is LOBED
* Vitelaria are only in the middle third of the body
* 8-12mm long x 1.5-3mm wide
Basically Clonorchis and Opisthorchis share the same morphology EXCEPT for the _________
Testes
Opisthorchis viverrini is found in _________ and surrounding countries in Southeast Asia.
It is called as __________
Thailand
Southeast asian liver fluke
Opisthorchis felineus is found in _______, _______, _____
It is also known as _________
* Most common hosts are cats
Eastern Europe,
Siberia, and the European Union
Cat liver flukes
_________ are more deeply lobed
Testes of viverrini
Yellowish brown, broadly ovoid
clonorchis and ophistorcis
first intermediate host of clonorchis and opisthorcis
parafossarulus, bulinus
bithynia
second intermediate host of clonorchis and opisthorcis
cyprinidae family of fresh water fish
clonorchis and opisthorchis have light infection it is asymptomatic but if symptomatic
Opisthorchiasis and Clonorchiasis
⚫Light infection
Asymptomatic
If symptomatic
Fatigue
Weakness
Altered appetite
* Diarrhea
* Weight loss
Abdominal pain
Enlargement of the liver
Opisthorchiasis and Clonorchiasis
Heavy infections
___________ by the adult worms
If the worms enter the _______, it can result to ________ and ________
Bile duct obstruction
gallbladder - cholecystisis and cholelithiasis
(gallstone formation
Opisthorchiasis and Clonorchiasis
Chronic infection
- Development of the parasite in the distal bile ducts provokes ____________ of the biliary epithelium
- This can lead to ________ and ________
intense inflammatory and proliferative changes
fibrosis of the liver and bile duct
Adenocarcinoma of the bile ducts and gallbladder
Cholangiocarcinoma
____________ and _______ have carcinogenic potentials; can initiate transformation of the bile duct epithelium
- Opisthorchis and Clonorchis
treatment and prevention for clonorchis and opisthorcis
praziquantel
proper human waste disposal
Intestinal Flukes
(6)
- fasciolopsis buski
Echinostoma ilocanum - Artyfechinostomum malayanum
- Heterophyes heterophyes
Metagonimus yokogawai
Gastrodiscoides hominis
Fasciolopsis adult
Intestine is ________
Testes is ________
Ovary is ________
Vitellaria are __________
* No cephalic cone and shoulder
Fasciolopsis adult
Intestine is unbranched
Testes is branched
Ovary is branched
Vitellaria are up to posterior end
* No cephalic cone and shoulder
Ventral sucker of _________ is bigger than fasciola
fasciolopsis
Yellowish brown
* Operculated
* Unembryonated
* Indistinguishable from Fasciola
egg
* Both can be found in the stool
Fasciolopsis egg
fasciolopsis first intermediate host
segmentina or hippeutis
fasciolopsis second intermediate host
aquatic plants
ipomea obscura (kangkong)
trapa bicornis (water caltrops)
elocharis tuberosa (water chestnut)
Pathology
* Enteritis due to the attachment of the adults manifests abdominal discomfort due to ________, nausea, vomiting and diarrhea.
* Some patients will develop _________
* Severe infections may cause _______ and eventually leading to __________
ulcer formation
anemia
ileus
intestinal obstruction
Fasciolopsis buski treatment and prevention
Praziquantel
boiling
Echinostoma first intermediate host
gyraulus convexiusculus
hippeutis umbilicalis
Echinostoma second intermediate host
pila luzonica
vivipara angularis
First intermediate host of artyfechinostomum malayanum
Gyraulus convexiusculus
Second intermediate host of artyfechinostomum
pila scutata
- Operculated
- Unembryonated
Cannot be differentiated from the egg of Fasciola and Fasciolopsis
Echinostoma Egg
Echinostomiasis
________ and _________
In heavy infection
inflammatory lesion occurs at the site of attachment and ulcers may develop
* Anemia
Abdominal pain and diarrhea
Echinostoma treatment and prevention
praziquantel
avoid eating raw snails
First intermediate host of heterophyes heterophyes
pirenella conica snail
second intermediate host
bolti and bouri fishes
- Ovoid
Light brown in color
Operculated with thickened rim
Fully embryonated when laid - Similar to Clonorchis and Opisthorchis but Posterior protuberance is absent
Heterophyes Egg
H hyterophyes occurs in ____, _____, _____
Asia
Egypt
hawaii
M yokogawai occurs in
Balkan
Far East
Spain
The most common intestinal fluke
Metagonimu yokogawai
Commonly inabit the small intestine
Heterophyes heterophyes and metagonimus yokogawai