Parasitic diseases of the liver

Parasitic diseases of the liver

• The liver is frequently a ff ected by parasitic infections, which, owing to the worldwide prevalence of these organisms, are responsible for considerable morbidity and mortality (see Chapter 6 ). Hydatid disease Human echinococcosis (hydatidosis, hydatid disease) is a para - sitic disease caused by the larval stages of cestodes (tapeworms) - of the genus Echinococcus . Medical treatment and diagnosis are discussed in Chapter 6 . Surgical intervention is occasionally required when medical management fails, and options range from liver resection or local excision of the cysts to deroofing with evacuation of the contents. Contamination of the perito - neal cavity at the time of surgery with active hydatid daughters should be avoided by continuing drug therapy with albenda - zole and adding preoperative praziquantel. This should be combined with packing of the peritoneal cavity with 20% hypertonic saline-soaked packs and instilling 20% hypertonic saline into the cyst before it is opened. A biliary communi - cation should be actively sought and sutur ed. Infection and Summary box 69.13 Infections of the liver /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Pyogenic liver abscesses 1/5000 admissions Worldwide billions of people have parasitic infections Parasitic infections cause live abscess and biliary tract damage Biliary tract involvement predisposes to cholangiocarcinoma Parasitic infections mimic pyogenic abscesses Obstructive jaundice from calci /f_i ed /f_l ukes or involvement of the biliary tract

greater omentum (an omentoplasty). Calcified cysts may be dead; however, if doubt exists as to whether a suspected cyst is active, it can be followed on ultrasonography as active cysts gradually enlarge and become more superficial.