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home - Biliary - Biliary Parasites - Clonorchis and Fasciola Written by Dr Sebastian Zeki

Clonorchis and Fasciola

TreatmentAcute disease: Chloroquine/mebendazole/albendazole/praziquantel/bithionol Chronic disease: Difficult- can use CBD wash with povidone iodine during ERCP Some of the ductal changes are reversible following successful treatment. Treatment Complications usually need endoscopic or surgical treatmentPraziquantel (75 mg/kg per day in three divided doses).Biliary ductal abnormalities may persist even after successful drug therapy. The metacercariae (the infective stage) migrate with epithelium of CBD and mature in IHD Usually penetrate smaller branches of left lobe of liverMature in about 1month and begin to pass eggs. The migration traumatises to the bile duct epithelium leading to ulceration and desquamation.Epithelial injury causes adenomatous hyperplasia and goblet cell metaplasia may develop as a result of epithelial injury, Get fibrous tissue formationResults in thickened bile duct (encapsulating fibrosis of the duct) Usually infected with repeated exposure rather than single episode Clinical manifestations Usually no symptomsSymptomatics: cholangitis, intrahepatic calculi, or cholangiohepatitis.Chronic infection assoc. with cholangiocarcinoma.Eggs can act as a nidus for stone formation. Mulberry-like appearance: multiple saccular or cystic dilatations of the IHD Arrow head sign: rapid tapering of the intrahepatic bile ducts to the periphery Decrease in the number of intrahepatic radicles due to portal and periportal fibrosis may lead to cirrhosis Adenomatous hyperplasia can cause scalloped duct CT: flukesappear as nonshado-ing echogenic foci/casts within bile ducts.The individual Clonorchis worms is visible as filamentous, wavy, and elliptical shaped filling defects Migration Is a Far Eastern trematode.It lives in the biliary tract of man and fish-eating animalsSimilar in life cycle and pathology to Opisthorchis viverrini(Laos and Thailand) .Opisthorchis felineus (Eastern Europe.) Chronic PhaseDevelops once infected bile ductStarts 2-3 months after ingestionClin pres: Charcot’s triadRarely with acalculous cholecystitis, severe hemobilia, and acute pancreatitis.Eggs canact as focus for stones formation Acute Phase: More frequent in sheep raising areas.Suspect when eosinophilia and RUQ pain with hx of watercress ingestion 1. Immature worms penetrate duodenal wall, migrate across peritoneal cavity, and enter the biliary passages through the capsule and liver parenchyma. 2. The larvae in the bile ducts elicit inflamm-tory reactions (toxic metabolites and mechanical effects) leading to necrosis and adenomatous changes of the epithelium, and biliary fibrosis. 3.These changes evolve into cystic dilatation, total or partial bile duct obstruction, and periportal cirrhosis. Raw vegetables infected withMetacercariae (infective stage) Resevoir in cattle and sheep Human oral ingestion Fasciola Hepatica —(=sheep liver fluke) Clonorchis Sinesis (=Chinese liver fluke) Biliary Parasites 1 Written by Dr Sebastian Zeki

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