Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

Liver Fluke Infections Liver Flukes 909

complications and prognosis

■Biliary obstruction, recurrent cholangitis, gallstones, cholangiocar-

cinoma. Prognosis good in absence of complications. Carcinoma has

poor prognosis. Cholangitis responds to antibiotics.

LIVER FLUKES

J. GORDON FRIERSON, MD

history & physical

History

■Life cycle: Eggs are passed in stool and hatch in water. Organisms

enter snails, reproduce, emerge from snail, and encyst on aquatic

vegetation. When vegetation is eaten by man or sheep, cysts hatch

and larvae penetrate the bowel wall, migrate through the liver to the

biliary tree, and mate, and eggs pass again in stool.

➣Exposure is by ingestion of watercress infected with metacer-

cariae. Exists in most countries in the world.

Signs & Symptoms

■Acute disease (when flukes are in liver): fever, RUQ pain, diarrhea,

nausea, vomiting. Signs include fever, tender RUQ, enlarged liver,

urticaria.

■Chronic phase: Often no symptoms or signs. May have continued

RUQ pain, hepatomegaly, jaundice.

tests

■Basic tests: blood: eosinophilia, may be pronounced

■Basic tests: urine: normal

■Specific tests: stool for O&P exam. Eggs may not be seen in early

phase of disease, and hard to distinguish from Fasciolopsis buski.

■Other tests: Serology using ELISA is useful. Ultrasound may show

flukes in biliary tree, and CT scan may show defects in liver where

worm has burrowed.

differential diagnosis

■Chlonorchis and opisthorchis infections, biliary tract disease,

cholangitis