PARASITOGENIC SURGICAL DISEASES

About 150 sorts of worms and their germs can parasitize in an individual’s organism. Solely a few of them have worth in surgical observe.

Echinococcosis is a illness of animals and folks, attributable to echinococcus. In dwelling animals — sheep, goats, cows, pigs — it parasitizes as a blister type, and canines, wolves, jackals, foxes that eat these animals, are contaminated and grow to be a supply of an infection for individuals. Echinococcosis is unfold in zones of intensive animal business.

The worms’ eggs, after they have into the particular person’s intestines, launch from their membrane, which ejects the germ and penetrates the intestinal wall, and later — the blood and lymphatic vessels. By the v. porte system, it is delivered to the liver, the place as much as 60–70% of the parasites begin to develop. Others penetrate into the big blood circulation and lungs the place as much as 10–15% of the germs are held. Much less typically the parasite will get within the left auricle and ventricle, then once more within the massive blood circulation the place the germs will be taken to any organ: kidneys, spleen, muscle mass, thyroid gland, the genitals, and so on. Thus, the liver is most frequently broken — 75%, lungs — 15%, much less typically different organs and tissues.

On the fixation place the germ looses its hook and begins to develop in a brand new type — hydatidosus, or blister. Echinococcus blister is a cystomic hole formation. The cyst has a chitinous membrane full of a clear white or opalesced liquid. The blister grows slowly — in 1 month the diameter will increase by 1 mm. The cyst can attain huge sizes. Rising, it compresses and atrophies the encompassing tissues, which, in its flip, causes aseptic productive irritation and the formation of a fibrous capsule.

On the inner floor of the chitinous membrane, in a so-called germinal layer, new (daughter) blisters and scolex are fashioned. Within the daughter blisters new generations of scolex — daughter blisters develop. The formation of daughter blisters can happen on the exterior floor of the chitinous membrane by their budding and the formation of a brand new cyst. Every of the quite a few blisters and remoted scolex are doubtlessly harmful regarding an infection. If throughout an operation the contents of the blister get on tissue, it’s essential to anticipate the unfold of the method. Impartial destruction of echinococcus is seldom marked — suppuration of the cyst, calcareousness of its capsule.

There aren’t any pathological indicators of an echinococcus cyst, regularly it reaches huge sizes asymptomatically, grows very slowly for 10–20 and even virtually 40 years.

The medical course of echinococcus illness has three levels:

Asymptomatic — begins with the larva (oncosphere) gettinginto tissue and until the incidence of the primary medical shows.

Stage of medical shows — predetermined by the strain ofthe cyst on the encompassing tissues and organs.

Stage of sophisticated echinococcosis: perforation, breaking ofthe cyst into the hole organs, belly cavity, pleural cavity. All that is accompanied by the ache syndrome. In case of suppuration of the echinococcus cyst, on the web site of swelling the ache amplifies, fever, intoxication, disgusting sweating are noticed.

If the cyst compresses very important organs ascites, mechanical jaundice, parasthesia can happen. With the breaking of the cyst into the bronchial tube — a variety of sputum is launched containing echinococcus blisters and fragments of the chitinous membrane. With injury to the bones pathological fractures, dislocations, infringements of joint features, formation of fistulae are noticed.

Analysis. Isotopes accumulation defects within the zone the place the cyst is positioned are decided on the scanning picture. Radiologically one or multichamber formations, typically with a stage of liquid or web site of calcification within the broken zone seem. Auxiliary shows are enlargement, shift, and deformation of the organ.

Angiographically the vascular sample turns into imprecise until the avascular zones is noticed. Throughout ultrasonic examination the formation, full of liquid, is decided. Throughout the laptop examination — cyst formations within the organ.

Laboratory: eosinophilia is revealed within the blood, constructive particular pores and skin allergic take a look at — the Casoni’s take a look at (0.2 ml diagnosticum are entered). Nevertheless, in 10–20% of the sufferers this response is absent.

Lately the Casoni’s take a look at is just not used due to pronounced sensitization of an organism (it could even trigger anaphylactic shock) and low diagnostic worth (in 20% of the instances there will be inaccurate outcomes). At present in prognosis, the agglutination response (the Fisherman’s response), protected and informative, is utilized.

Therapy of echinococcosis is principally surgical — radical echinococcectomy, elimination of the cyst with the capsule or with part of the organ. Whether it is inconceivable to take away the parasite, an open echinococcectomy, stopping the unfold scolex into the tissue, is carried out. The contents are deleted; the chitinous membrane and part of the fibrous membrane are incised. The cavity is processed with antiseptics having a particular motion (formalin, hypertonic resolution of sodium chloride with hydrogen peroxide) and drainage. With a purpose to cut back the cavity, the capsule is typically sutured.

Human alveococcosis is a illness with major injury of the liver by larva (alveolar or multichamber echinococcosis).

Fundamental hosts for the helminth — arctic fox, fox, canine, cat (the intestines are parasitized by the sew helminth).

The larval stage takes place within the organism of rodents (mice, muskrats) and people. Arctic foxes, foxes, canines, cats are contaminated when consuming mice containing the parasite of their intestines; the parasite reaches sexual maturation and launch oncospheres. An individual is contaminated by utilizing meals and water, whereas eradicating contaminated animal’s pores and skin, in addition to throughout contact with pets — canines, cats. From the intestines, the larvas get into the liver the place they develop. Metastasing happens within the lungs and mind. By their look, the nodes remind porous cheese, and small cavities with putriform contents are noticed of their layer. In case of suppuration abscesses within the liver, cholangitis come up. The illness develops for a very long time. Main indicators of the illness will be cholangitis, mechanical jaundice, metastasises of alveococcosis within the lungs and mind. Tumourous formations within the liver can attain vital sizes subsequently the liver will increase, turns into dense, however ache is just not current. With a purpose to set up the prognosis allergic exams are taken into consideration (eosinophilia, the Casoni’s take a look at and hemagglutination with latex, which yields constructive leads to 70–75% of sufferers).

For prognosis roentgenography, angiography, tomography, radionuclide scanning, echography, laptop tomography, in addition to roentgenography of the thorax and neurologic examination are used.

Therapy: hepatic resection along with the node is carried out, different tissue is infiltrated with antiparasitic options (0.1% resolution of trypaflavin — 20 ml). Levamisol, mebendazol are utilized in antiparasitic remedy.

Preventive measures of echinococcosis, alveococcosis consist in strict following the epidemiological mode, the contaminated organs of animals needs to be eradicated. It’s obligatory to forestall contact with canines, particularly for kids who don’t perceive the hazard of an infection and the implications. Veterinary supervision for service canines is necessary.

Ascariasis is intestinal helminthiasis. The causative agent: spherical ascaride helminth; supply of an infection — individuals. The worms’ eggs, excreted with excrements, mature within the floor. With polluted greens, fruit, grime they enter the digestive tract. By means of the mucous membranes of the small intestines the larvae go deep into v. porta and penetrate the liver and additional get to the lesser circulation. Within the lungs the larvae depart the vessels, go deep into the bronchioles, then into the bronchial tubes, pharynx, with sputum enter the abdomen and intestines the place they attain sexual maturity. Ascariasis can result in issues, which require surgical therapy.

Intestinal impassability develops with the obstruction of the intestinal orifice by parasites. The medical image is much like obturation obstruction. In case of inefficiency of conservative therapy, surgical intervention is carried out: they separate the ball of ascaride and transfer them to the orifice of the big gut with following dehelminthization.

Ascariasis of appendicitis has no particular shows. Ascarides within the appendix are an operational discover.

Ascariasis of the liver and biliary methods is noticed seldom, the parasite will get via the papilla and trigger congestion of bile secretion. The medical image is characterised by mechanical jaundice, purulent cholangitis, hepatic abscesses. Retrogradic cholangiography, ultrasonic examination, laptop tomography help in figuring out the prognosis.

Therapy is surgical: cholecystectomy, choledochotomy, elimination of the ascarides and exterior drainage of the biliary methods, opening and draining the hepatic abscess.

Ascariasis of the pancreas develops when ascarides fill the bile excretion tract. It seems as persistent indurative or acute pancreatitis.

Throughout ascaride perforation of the GIT organs the medical image of peritonitis develops.

Postoperative issues of ascariasis are predetermined by the migration of ascarides after the operation.

Making an allowance for the severity of surgical issues of ascariasis, inspection of sufferers on the eve of an elective operation is indicated; in case of unveiling ascariasis dehelminthization is carried out.

Opisthorchosis is helminthiasis of the hepatobiliary techniques and pancreas. The causative agent of opisthorchosis is siberian or feline opisthorchis. Fundamental hosts are individuals, cats, canines, foxes, white foxes. The intermediate host is carp fish (ide, roach, bream, and so on.).

Helminths’ eggs get in to water with excrements and are swallowed by mollusks, the place they flip into larva which enter the water and actively get within the physique of fish, the place encyst within the muscle mass and the hypodermic tissue. Using unthoroughly fried and salted fish that comprise helminth germs, leads to the an infection of an individual. Within the liver the helminths trigger the event of necrotic and dystrophic processes. Essentially the most typically issues — purulent cholangitis with the formation of hepatic abscesses. Continual opisthorchosis regularly leads to liver most cancers. Injury to the pancreas by opisthorchosis can entail acute pancreatitis, and persistent injury results in pancreatic most cancers. Pathological signs are usually not noticed, subsequently the prognosis is decided on the idea of medical and particular strategies of examination, the presence of helminth eggs within the duodenal contents.

Therapy. Dehelminthization is carried out on the eve of the operation and after it. Chloxilum (chloroparaxinolum) is appointed in keeping with a particular scheme as an antihelmintic means.

Amebiasis is a illness attributable to amoeba with prevailing ulcer injury to the big intestines, doable hematogenous dissemination of the agent into the inner organs (the liver, the lungs, the mind, and so on.) with the event of abscesses. The illness is unfold in tropical nations. The essential supply of an infection is individuals who excrete the cysts of amoebas with feces. The cysts of amoebas which get within the digestive tract consequence within the improvement of the illness. Within the massive gut, the amoeba get within the submucous layer, necrosis (ulcers) develops round them. By means of the vessels, the amoebas get within the blood and unfold into different organs (liver, lungs, and so on.) the place they trigger the formation of abscesses. Ulcers within the intestines can perforate inflicting peritonitis.

The medical image of amebiasis of the intestines is much like the image of bacterial dysentery; it’s characterised by normal signs of intoxication (fever, weak spot, indisposition), typically defecation with slime and blood.

The prognosis is confirmed when amoebas are revealed in feces, and with the assistance of particular serological response. In case of intestinal perforation the prognosis is decided on the idea of the medical image of peritonitis, however with extreme intoxication signs of irritation of the peritoneum are pronounced poorly. With gangrene of the intestines they resort to its resection with the formation of colostoma. If the opening will be sutured, they do it and nothing extra. Typically amoeboid colitis involves an finish with the event of amoebic granuloma — across the ulcer an inflammatory infiltration is fashioned. By the morphological construction that is persistent productive irritation with eosinophilic infiltration and necrosis of cells. The cecum and the ascending colon are extra typically broken. Colonoscopy and figuring out amoebas in stool play an necessary position in prognosis. Amoebic granuloma leads to obturation obstruction. Therapy is conservative. In case of inefficiency of conservative therapy and issues they resort to surgical therapy.

Appendicitis throughout amebiasis is predetermined by the event of particular ulcers. Attribute attributes are usually not current.

The illness can have indicators of intestinal bleeding.

Therapy is conservative with compulsory utility of antiamebic preparations. Surgical therapy is launched solely with very important indications (in case of inefficiency of therapeutic means), in addition to resection of the bleeding gut is carried out.

Hepatic abscesses is essentially the most typically issues of amebiasis, noticed in 2–10% of the instances. These abscesses shouldn’t have a pyogenic membrane as a result of their contents irritate the tissue. The contents is pus with a haemorrhagic coloring with out an odour. The accompanied secondary an infection offers an odour to the purulent contents and alter shade. The medical image is much like hepatic abscesses: intoxication, ache, enlargement of the liver, icterus. Radiological, radioisotope examination, ultrasonic and laptop tomography, amoebas presence verify the abscess prognosis.

Therapy needs to be complicated and embody antiamebic, antibacterial and disintoxication remedy. The primary methodology of therapy is punctuation with the elimination of the contents and introduction of antibacterial and antiamebic preparations. With its inefficiency they resort to operative intervention (opening, drainage and corresponding conservative therapy).

Metastasing of amoebas to the lungs causes pneumonia and abscess of the lungs. The medical image is much like that one for any microflora. To deal with the abscess they apply bronchial sanation, with the absence of a constructive impact, a puncture of the abscess with the aspiration of the pus with introduction of medical merchandise is carried out.

Amoebic abscess of the mind is noticed seldom. Therapy: antiamebic and antibacterial preparations, and elimination of the abscess along with the capsule.

With the presence of every kind of amebiasis complicated therapy with compulsory utility of antiamebic means is carried out: Emetinum, metronidazole (trichopol, flagyl), chingamin (delagil) in keeping with sure schemes said in the middle of the infectious illnesses. Preventive measures of surgical issues of amebiasis consists generally epidemic actions and lively therapy of sufferers with amebiasis of the intestines.

Filariasis is the final identify for helminthiasis attributable to filaria. Wuchereriosis and brugiosis have gotten the best worth in surgical procedure. They’re characterised by injury to the lymphatic system. Filariasis is widespread among the many inhabitants of tropical nations: Africa, South America, Southern Asia. The helminthes parasitize the lymphatic vessels and nodes. Their larvas are in lymph and blood, supply of invasion — sick particular person, monkey, canine, and cat. The larvae are transmitted by mosquitoes of the household Anophelex, Kulex, and so on. The event of microfilariasis lasts for 8–35 days. The expansion and improvement of the helminths within the lymphatic vessels leads to infringement or full termination of lymph circulation in vessels. Lymphostasis leads to elephantiasis.

Medical image. Fever, headache, normal weak spot. Lymph nodes are dense, painful, lymphatic vessels appear like dense cords of pink shade, painful throughout palpation.

Lymphangitis spreads from the proximal elements to the distal. The first focus of irritation is absent. Lymphangitis precedes the rise of the axillary and inguinal lymph nodes. At totally different websites of the physique, a stratching rash like urticaria, seems. Steadily the irritation decreases, and in some months or years renews. In 2– 7 years the secondary stage — lymph vessels varicosis, lymphostasis, ruptured vessels, lymphorrhea start. The lymph nodes are sharply enlarged. The accompanied secondary an infection leads to the event of phlegmons, abscesses. The third stage of the illness is characterised by improvement of elephantiasis, extra typically on the legs, breast, and vulva.

The prognosis is decided on the idea of the medical image and revealing microfilaria within the blood.

Therapy. Throughout the preliminary levels: antiparasitic remedy — ditrasine citrate (baroside, tetrazine) a dose of 0.1 g 3 times a day for 7–10 days. The management over therapy is carried out if the microfilarias are discovered within the blood. If obligatory, the therapy is repeated. With the presence of secondary an infection antibacterial remedy is appointed. Abscesses, empyema pleuras, peritonitis are topic to surgical therapy. With elephantiasis the modified tissue is totally incised with following dermaplasty. Surgical therapy is critical even when the parasites are usually not discovered within the blood. If they’re revealed once more, dehelminthization after which surgical therapy are carried out.

Paragonimiasis is a illness attributable to helminths which injury primarily the lungs and mind of an individual. It’s noticed within the Far East (China, Japan, Korea, Philippines), in addition to in Africa, South America. The causative agent: trematode. Fundamental host: individuals, cats, canines, pigs, tigers, mongoose. Extra hosts: fresh-water crabs and crayfish.

The eggs excrete with sputum, much less typically with excrements, get in to the water, in 4 weeks larva come out, penetrate into the physique of mollusk and switch into cercaria. The cercaria depart the mollusk and penetrate the physique of crabs or crayfish the place encystment happens. The utilization of crabs or crayfish that are insufficiently thermally processed leads to an infection. Within the small gut immature paragonimuses depart metacercaria and, perforating the intestinal wall, penetrate into the free belly cavity, transfer in the direction of the diaphragm and thru it get into the lungs, the place they settle and mature. Across the parasite irritation takes place with development of connective tissue cysts, full of pus, parasites and their eggs. Retropulmonary types of paragonimiasis consequence from hematogenous metastases from the lungs in case of destruction of pulmonary tissue and vessels. Within the mind, a number of cysts are noticed.

The medical image of paragonimiasis is decided by the interval of deepening, migration and improvement of the parasite. First the belly syndrome is noticed, characterised by enteritis, phenomena of acute abdomen, acute hepatitis. The rooting of the parasite within the lungs has medical shows, reminiscent of bronchopneumonia, acute bronchitis, haemorrhagic pleurisy. Later there are such signs as ache within the chest, paroxysmal cough within the morning with purulent sputum, pneumorrhagia, fever. Throughout auscultation rattles are decided, extra typically moist. Ceaselessly pulmonary bleedings, dyspnea happen. Intoxication causes tachycardia, dystrophic adjustments within the myocardium, neurologic semiology — headache, dizziness, fatigue.

Paragonimiasis of the mind seems as meningitis or meningoencephalitis which develops towards a background of pulmonary paragonimiasis. The essential signs — vital headache, convulsive epileptic assaults with full or partial lack of consciousness, dizziness, narrowing of the visible area and reduce in visible acuity. Laparoscopic or throughout laparotomy haemorrhagic, fibrinous and fibrinopurulent effusion is marked; throughout microscopic examination immature types of helminths are noticed. It’s essential to think about the anamnesis — the usage of meat, crabs, crayfish, paragonimiasis dwelling within the epidemic place. These sufferers’ sputum has a chocolate or vibrant pink shade, viscous; microscopic examination reveals a congestion of parasites eggs. Within the blood: eosinophilia, regularly lymphocytosis, hypochromic anemia. The intradermal take a look at with particular antigene is constructive, nice itching, lymphangitis. Radiological examination reveals extra typically small or massive blister-like, linear, ring-shaped, diffuse shadows within the center space of the lungs.

With paragonimiasis of the mind the medical image, mind signs, laboratory examination, epidemiological parameters enable to find out the proper prognosis. The topographical prognosis is decided on the idea of radiological and angiographic investigations.

Therapy is conservative — Bithiolum internally for 10 days within the dose of 30–40 mg/kg of weight a day 2–3 instances. Inefficiency of conservative therapy, repeated pulmonary bleedings, progressing exhaustion, and fixed pneumorrhagia are indications to surgical therapy (pulmonary resection). With injury to the mind, indications for surgical therapy (elimination of the cyst) are improve in psychological and neurologic signs, inefficiency of conservative therapy.Fascioliasis is helminthiasis with injury of the hepatobiliary system. It’s noticed in France, Cuba, in our nation it’s uncommon. The causative agent: fasciola hepatic. Fixed host: individuals, massive and small horned cattle, pigs, horses. Intermediate host: mollusk, small leaches. From the helminth’s eggs that are in water, larvae depart and penetrate the mollusk. The larva which develops within the mollusk’s physique enters the water, the place it encapsulates. From the reservoir the larva will get into an organism and locates within the biliary tract, the gallbladder, hardly ever in different organs. Fasciola hepatic which parasitizes within the biliary tract, damages the epithelium. Such situations are favorable for the penetration of purulent microflora, which, in flip, causes cholecystitis, hepatic abscesses, cholangitis, mechanical jaundice, which require surgical therapy. Sufferers with fascioliasis show attributes of an inflammatory illness of the gallbladder and channels. Throughout an operation on the biliary tract and within the cavity of an abscess it’s doable to seek out fasciola hepatic. Surgical intervention is carried out historically, antiparasitic therapy is carried out with the assistance chloxil or emetine hydrochloride.