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Y3R5: Medicine I 🩺 > L7: Parasitic Infections of The Liver > Flashcards

L7: Parasitic Infections of The Liver Flashcards

1
Q

Parasitic infections of the liver can present a difficult and fascinating diagnostic puzzle.

A

…

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2
Q

Diagnosis usually requires a careful history and physical examination

A

…

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3
Q

Sometimes travel history, occupation, and recreational exposures provide clues.

  • For example, a variceal bleed in an Egyptian patient with no stigmata of chronic liver disease may prompt consideration of schistosomiasis
A

…

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4
Q

Parasites affecting the liver

A
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5
Q

Protozoa affecting the liver

A

 Amebic hepatitis and amebic liver abscess
 Malaria
 American trypanosomiasis (Chagas’ disease)
 Leishmaniasis (Kala-azar)

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6
Q

Helminthes affecting the liver

A

 Hepatic schistosomiasis
 Echinococcosis
 Clonorchiasis and opisthorchiasis
 Fascioliasis
 Visceral larva migrans

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7
Q

CA of Ameobic Liver Abscess

A

Entamoeba histolytica.

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8
Q

Transmission of Ameobic Liver Abscess

A

Ingestion of contaminated food.

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9
Q

Distribution of Ameobic Liver Abscess

A

worldwide; more in tropics and areas with poor sanitation.

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10
Q

age affected by Ameobic Liver Abscess

A

usually between 20 and 40 years of age.

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11
Q

E. histolytica usually causes …..

A

dysentery

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12
Q

Sex affected by Ameobic Liver Abscess

A

More frequent in males

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13
Q

Liver affection results when organisms traverse the bowel wall and reach the liver via the portal vein.

A

…

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14
Q

Hepatic amebiasis may be …..

A

a) Diffuse (acute non-suppurative hepatitis).

b) Amebic liver abscess.

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15
Q

Many patients were found to have severe immunosuppression, the most common causes being HIV and tuberculosis.

A

….

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16
Q

CP of Ameobic Liver Abscess

A
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17
Q

Symptoms of Ameobic Liver Abscess

A

 Fever and abdominal pain: in 80-90% of patients.
 Nausea, diarrhea, weight loss.
 Cough: sometimes but not reliably present.
 Amebic dysentery.

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18
Q

Signs of Ameobic Liver Abscess

A
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19
Q

INVx of Ameobic Liver Abscess

A
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20
Q

Investigations for Ameobic Liver Abscess

  • Amoebic Serology
A

positive in 99% of patients.

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21
Q

Investigations for Ameobic Liver Abscess

  • Amoebic Cysts
A

may present in stools.

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22
Q

Investigations for Ameobic Liver Abscess

  • Imaging Of the Liver
A
  • A single cavitating area is seen, often with areas of solid liver tissue within it; occasionally, multiple abscesses are seen.
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23
Q

Investigations for Ameobic Liver Abscess

  • CBC
A

Neutrophil leucocytosis is seen with mild anemia.

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24
Q

Investigations for Ameobic Liver Abscess

  • ARPs
A
  • Low albumin, raised CRP, ESR and alkaline phosphatase, elevation of transaminases and
  • Rarely, raised bilirubin are found.
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25
Q

Investigations for Ameobic Liver Abscess

  • Blood Culture
A

Sterile

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26
Q

Investigations for Ameobic Liver Abscess

  • Aspiration
A

If the abscess is aspirated: anchovy sauce color, it does not have a foul smell (anaerobic bacteria).

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27
Q

TTT of Ameobic Liver Abscess

A
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28
Q

TTT of Ameobic Liver Abscess

  • metronidazole
A

Metronidazole: 750 mg 3 times a day orally for 10 days

  • Curative in 90% of patients.
  • The drug also is available for IV administration.
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29
Q

TTT of Ameobic Liver Abscess

  • Tinidazole
A

Tinidazole, another nitroimidazole closely related to metronidazole, approved for the treatment of ALA and invasive amebiasis as effective as metronidazole.

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30
Q

TTT of Ameobic Liver Abscess

  • Luminal Agents
A
  • Administration of luminal agents (iodoquinol and paromomycin) should follow to eradicate E. histolytica residing in the colon.
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31
Q

TTT of Ameobic Liver Abscess

  • Percutaneous aspiration
A

If needed, percutaneous aspiration of amebic liver abscesses can be safely performed

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32
Q

Possible Complications of Ameobic Liver Abscess

A
  • The abscess may rupture into the abdominal cavity, the pleura, the lungs, or the pericardium.
  • The infection can also spread to the brain.
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33
Q

Another Name of American Trypanosomiasis

A

Chagas Disease

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34
Q

CA of American Trypanosomiasis

A

Caused by a protozoa (T. cruzi)

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35
Q

What transmits T.Cruzi?

A

Transmitted by the red winged bug (kissing bug).

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36
Q

CP of American Trypanosomiasis

A
  • Hepatosplenomegaly and mildly abnormal liver enzymes are common in the acute phase.
  • With the development of cardiomyopathy, passive liver congestion is commonly seen with chronic disease.
  • Other gastrointestinal manifestations include megacolon and megaesophagus.
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37
Q

Trypomastigote & Amastigotes in American Trypanosomiasis

A
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38
Q

CA of Leishmaniasis

A

Caused by protozoan parasites transmitted by the sand fly in tropical regions.

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39
Q

MOT of Visceral Leishmaniasis

A

Infection can be localized to the skin or spread throughout the reticuloendothelial system.

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40
Q

Kala-azar refers to ……

A

severe visceral leishmaniasis

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41
Q

CP of Visceral Leishmaniasis

42
Q

Liver Histopathology in Visceral Leishmaniasis

A

Liver histopathology can show granulomas or severe fibrosis

43
Q

labs in Visceral Leishmaniasis

A

Modest increases in hepatic transaminases and alkaline phosphatase are common

44
Q

Dx of Visceral Leishmaniasis

A

Usually made by bone marrow biopsy, though splenic aspiration is a highly sensitive test (> 95%).

45
Q

TTT of Visceral Leishmaniasis

A

Pentavalent antimony compounds, pentamadine, or amphotericin B can be used for treatment

46
Q

CA of Hepatic Shistosomaisis

A

Schistosoma mansoni

47
Q

MOT of Hepatic Shistosomaisis

A

penetration of the skin by the infective cercaria of S. mansoni

48
Q

Normal Habitat of Hepatic Shistosomaisis

A

Colonic venous plexus.

49
Q

Main Pathology of Hepatic Shistosomaisis

A

in the colon is bilharzial dysentery.

50
Q

Sequalae of Hepatic Shistosomaisis

A

include colonic polyposis, hepatosplenic, and cardiopulmonary schistosomiasis.

51
Q

Pathogenesis of Liver Affection in Hepatic Shistosomaisis

52
Q

Stages of Hepatic Shistosomaisis

53
Q

Stage of shrunken liver and splenomegaly

A

Severe portal hypertension, collaterals may appear during this stage and hypersplenism may develop.

54
Q

Ascetic stage

A

Due to portal hypertension and hypoalbuminemia.

55
Q

Dx of S.Mansoni

A

Direct & Indirect Method

56
Q

Direct Methods in Dx of S.Mansoni

A

A) Stool analysis: specific (100%) but of low sensitivity (40%)

B) Rectal snip biopsy: sensitive and specific.

C) Liver biopsy.

57
Q

Indirect Methods in Dx of S.Mansoni

58
Q

TTT of S.Mansoni

59
Q

What are Anti-Bilharzial Drugs?

A
  • Praziquantel
  • Oxamniquine
  • Mirazid
  • Endoscopic Polypectomy
60
Q

MOA of Praziquantel

A

The drug causes vacuolization of schistosoma tegument leading to disruption of the apical tegmental layer.

61
Q

What is another name of Echinococcus?

A

Hydatid Disease

62
Q

CA of Cystic echinococcosis

A

E. granulosus

63
Q

CP of Cystic echinococcosis

A

It is typically a solitary slowly- growing hepatic cyst with potential for rupture and secondary complications.

64
Q

CA of Alveolar echinococcosis

A

E. multilocularis

65
Q

CP of Alveolar echinococcosis

A

An aggressive disease which often behaves like a malignancy.

66
Q

Geography of E. granulosus

A

occurs mainly in sheep-raising areas where canines eat the viscera of infected sheep.

67
Q

Geography of E. multilocular

A

occurs in only the northern hemisphere, often in arctic areas.

68
Q

Human is an ……. host (dead - end host).

A

intermediate

69
Q

CP of E. granulosus

70
Q

Infection by E. granulosus

A
  • Although most E. granulosus infections are acquired in childhood
  • The disease usually does not present until the fourth decade or later, as cystic lesions are usually slow-growing.
71
Q

Most of …… are asymptomatic

A

E. granulosus infections

72
Q

CP of E. granulosus

A

 About 80% of cases present as a solitary hepatic cyst, most commonly involving the right lobe.

 Less frequently, multiple cysts can be seen within the liver or in extrahepatic sites.

 As cysts grow larger than 5 to 10 cm, patients may begin to experience right upper quadrant abdominal discomfort and nausea.

73
Q

When do patients infected with E. granulosus present with manifestations?

A

 As cysts grow larger than 5 to 10 cm, patients may begin to experience right upper quadrant abdominal discomfort and nausea.

74
Q

Complications of E. granulosus

75
Q

Dx of E. granulosus

76
Q

Dx of E. granulosus

  • Hx
A

Diagnosis can usually be made from the patient
history and medical imaging.

77
Q

Dx of E. granulosus

  • Serology
A

Serology can be helpful, but has variable sensitivity.

78
Q

Dx of E. granulosus

  • rads
A

Ultrasound or CT scan may reveal a smooth, round
cyst, internal septations and hydatid sand are often
visualized as well.

79
Q

Cysts that appear heavily calcified are usually ……., and treatment may not be required.

A

non-viable

80
Q

Protoscoleces of E.Granulosus

81
Q

TTT of E. granulosus

82
Q

First Line Therapy of E. granulosus

A

First line therapy for cystic echinococcosis remains surgery, usually without the infusion of a protoscolicidal agent.

83
Q

PAIR Technique in TTT of E. granulosus

A

PAIR (Puncture, Aspiration, Injection and Reaspiration) is an ultrasound-guided percutaneous technique.

84
Q

Albendazole in TTT of E. granulosus

A

Albendazole (10 - 15 mg / kg per day in 2 divided doses) is given several days before and 2- 3 months following treatment.

  • May be given alone for 3-6 months.
85
Q

What is F. Hepatica?

A

Fasciola hepatica is a liver fluke (trematode) that occurs in temperate sheep-raising areas throughout the world.

86
Q

Transmission of F. Hepatica

87
Q

CP of F. Hepatica

88
Q

IP of F. Hepatica

A
  • Typically fascioliasis presents one to 3 months after ingestion of metacercariae (acute fascioliasis) with fever, nausea, abdominal pain, hepatomegaly, and eosinophilia.
89
Q

CP of F. Hepatica

A
  • Occasionally hemobilia, subcapsular hematomas, or extrahepatic masses may occur.
  • Even though chronic infection is generally asymptomatic, biliary obstruction can occur.
90
Q

CP of Chronic F. Hepatica

A
  • Even though chronic infection is generally asymptomatic, biliary obstruction can occur.
91
Q

Dx of F. Hepatica

92
Q

Dx of F. Hepatica in acute Cases

A

Whereas stool examination for ova and parasites is typically negative in acute infection, serologic tests (ELISA) are usually diagnostic.

93
Q

Rads in Dx of F. Hepatica

A
  • US may reveal an elongated, mobile and floating structure, 5-23 mm inside dilated CBD with no acoustic shadow.
  • CT scanning may show characteristic tortuous tracks indicative of worm migration.
94
Q

Dx of F. Hepatica in Chronic Cases

A

Unlike acute infection, chronic infection is associated with characteristic ova detectable by stool examination.

95
Q

TTT of F. Hepatica

A

Triclabendazole is the only treatment for fascioliasis

96
Q

What are Clonorchis sinensis and opisthorchis?

A

Clonorchis sinensis and opisthorchis species are parasitic flukes (trematodes).

97
Q

geography of Clonorchis sinensis and opisthorchis

A

 Infection is most common in the Far East, Southeast Asia, and parts of the former Soviet Union.

 Cases have been reported in non-endemic areas due to the importation of fish products.

98
Q

CP of Clonorchis sinensis and opisthorchis

A

Clinically like fascioliasis but carcinogenic.

99
Q

TTT of Clonorchis sinensis and opisthorchis

A

Praziquantel (75 mg/kg in three divided doses for 1 day) is highly effective.

100
Q

Done

Y3R5: Medicine I 🩺 (47 decks)

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