Biliary ascariasis

　　The causes of biliary ascariasis, in addition to ascaris in the intestines or bile ducts, are mainly some predisposing factors, such as:

　　1) Changes in the environment of the intestinal lumen occur when fever or diarrhea occurs

　　2) Insufficient dosage of anthelmintic drugs not only fails to expel the worms but also stimulates the increased activity of ascaris

　　3) A decrease in the acidity of the intestinal lumen caused by drugs or food can significantly increase the upward movement of ascaris. After understanding the causes of ascaris disease in the biliary tract, we can take better preventive measures to prevent its occurrence.

　　What complications can ascaris disease in the biliary tract lead to

　　It is not necessary for ascaris to enter the biliary tract immediately after entering, and complications may only occur when the body's resistance decreases, the biliary tract is obstructed, and the bile drainage is not smooth. Common complications of ascaris disease in the biliary tract include:

　　1. Biliary tract infection. For example, suppurative cholangitis, accounting for 40% of complications of biliary tract infection; or cholecystitis, accounting for 40% of complications of biliary tract infection; or septic shock, accounting for 6% of complications of biliary tract infection. At this time, in addition to severe pain in the upper right abdomen, patients often have chills, high fever, jaundice of the skin and sclera, and increased abdominal distension. Physical examination shows expanded tenderness in the upper right abdomen, with muscle tension. If biliary obstruction occurs, an enlarged gallbladder can be palpated.

　　2. Biliary hemorrhage. The incidence is 3.5%, and it often occurs on the basis of biliary tract infection, with symptoms such as fever, abdominal pain, followed by hematemesis and melena.

　　3. Liver abscess. Ascaris can penetrate into the liver along the biliary tract to cause liver abscess. Or on the basis of cholangitis, secondary hepatitis and liver abscess may occur. Liver abscess is often multiple scattered small abscesses, and when the abscess ruptures, it can cause subdiaphragmatic abscess or empyema.

　　4. Cholelithiasis. The incidence is about 19%, and the remnants of ascaris, fragments, or residual keratin in the biliary tract can become the core of stones, forming gallstones. Most of these stones are bilirubin stones.

　　5.蛔虫还可穿破胆道形成胆漏，或穿入肝静脉，严重者可穿入肝脏后再钻入肺，引起肺出血性梗死和肺脓肿。

　　What are the typical symptoms of biliary ascariasis

　　⒈ Children and adolescents are more common, and there is often a history of worm expulsion.

　　⒉ There is a sudden paroxysmal sharp pain in the upper abdomen, like a drill, during the intermission, as if a normal person.

　　⒊ During colic, there are nausea and vomiting, which can vomit out worms and often radiate to the right scapula or back.

　　⒋ In the later stage, there are manifestations of cholangitis and various complications.

　　⒌ The abdominal muscles are soft, with only deep pressure pain under the xiphoid process or in the upper right abdomen.

　　⒍ There are no signs during the intermission.

　　How to prevent biliary ascariasis

　　Reduce or eliminate the infection of intestinal ascaris to reduce the occurrence of biliary ascariasis. The following points should be noted:

　　1) It is necessary to strengthen health education in urban and rural areas and manage feces harmless to the environment.

　　2) Individuals should pay attention to dietary hygiene, not eat unclean cold food, to cut off the source of infection and reduce the infection rate of intestinal ascaris.

　　3) Those with positive worm egg tests should actively receive anthelmintic treatment and fully cooperate with the treatment, and should not stop halfway to prevent further increase or activity of the worms.

　　4) Reports indicate that regularly taking acidic substances (such as hawthorn, vinegar, etc.) also plays a certain positive role in the prevention of biliary ascariasis.

　　6) Children over 2 years old should take anthelmintic medicine regularly.

　　7) Improve dietary structure, actively exercise, enhance physical fitness, and increase resistance.

　　About the examination methods for biliary ascariasis:

　　Inquire about the patient's medical history to see if there is a history of ascariasis.

　　Perform blood tests, and the results of blood tests for patients with the disease show that the white blood cell count is usually normal or slightly elevated, and the count of eosinophils in the blood often increases.

　　Examine the duodenal drainage fluid for worm eggs; fecal smear method or saline floatation method can easily detect worm eggs. In recent years, the improved Kato method is commonly used. This method has a high detection rate for worm eggs.

　　Perform a fecal examination, as it is easy to find worm eggs in the fecal excrement.

　　Perform a B-ultrasound examination, and a B-ultrasound showing the presence of ascaris echo in the bile duct can confirm the diagnosis.

　　Intravenous cholangiography, endoscopic retrograde cholangiopancreatography, or cholangiography through a T-tube can help doctors diagnose whether it is biliary ascariasis.

　　Ascariasis is more common in children and can affect their physical health and growth and development. In addition to taking Western medicine such as mebendazole, levamisole, and anthelmintic, the following simple dietary treatments can also be used:

　　1. Pepper Seed Powder Composition: 5 grams of carrot seeds, 5 grams of Sichuan pepper powder. Method of use: Gently roast the carrot seeds, grind them into powder, mix with Sichuan pepper powder, take on an empty stomach, twice a day. Effect: Strengthen the spleen and expel worms.

　　2. Peach Leaf Juice Drink Composition: 60 fresh peach leaves. Method of use: Clean and mash the fresh peach leaves, then soak them in boiling water and take them with the residue. Effect: Relieve worm and expel worms.

　　3. Composition of Pepper and Mung Bean Powder: Four large grains of pepper and mung beans each. Method of use: Grind the two ingredients into fine powder, and take with wine. Effect: Relieve worm and pain.

　　4. Sichuan Pepper and Plum Decoction Composition: 10 grams of Sichuan pepper, 15 grams of black plum. Method of use: Boil the above two ingredients in water. Take two doses a day, taken in portions. Effect: Expel ascaris.

　　5. Sesame and Scallion and Plum Decoction Composition: 250 grams of sesame straw, 50 grams of scallion white, 30 grams of black plum. Method of use: Boil the above three ingredients in water and take them on an empty stomach. Take two doses a day for 3 days. Effect: Calm the worms and expel them.

　　6.丝瓜仁：Remove the skin and take the kernel of a moderate amount of black unripe loofah, take it with warm water on an empty stomach. Take 50 seeds each time, once a day. It can calm the worms and expel them.

　　7. Peach Leaf Juice Drink: 60 leaves of fresh peach leaves. Wash the fresh peach leaves clean, beat them into a pulp, and pour boiling water over them. Take the decoction with the dregs. It can calm the worms and expel them.

　　The main purpose of drug treatment for biliary ascariasis is to relieve spasm of the bile duct and Oddi's sphincter, relieve pain, expel ascaris, and treat infection. The specific medication is as follows:

　　1. Spasm and Pain Relief:①Atropine: Atropine is an anticholinergic drug that can relieve smooth muscle spasm. ②Pethidine: Pethidine can inhibit the pain area of the cerebral cortex, has analgesic effects, but at the same time excites the smooth muscle of the bile duct, increases tension, causes Oddi's sphincter contraction, and even spasm, so it must be used with atropine to achieve a better analgesic and antispasmodic effect.

　　2. Ascaris Treatment:Currently used anthelmintics include: ①Telmecotide: An artificial synthetic benzimidazole broad-spectrum anthelmintic, clinical application shows that it has a good curative effect on ascaris, hookworm, pinworm, tapeworm, and whipworm. The egg-negative rate of ascaris disease treatment is 83% to 100%. ②Levamisole: A broad-spectrum anthelmintic. This drug can expel ascaris, hookworm, and pinworm. The egg-negative rate of ascaris disease treatment is 95% to 98%, with the best effect. ③Albendazole: A broad-spectrum and highly effective anthelmintic that interferes with the absorption of glucose and various nutrients by the worm body, causing the worm body to fatigue and die. ④Thiabendazole: Inhibits the activity of cholinesterase in the worm body, interrupts the transmission of information between the nervous and muscle tissues, causing the worm body to be paralyzed and excreted from the body.

　　3. Treatment of Infection:Antibiotics are generally not recommended for use. However, they can be applied for suspected concurrent infections or confirmed infections. Since the bacteria carried by ascaris into the bile duct are mostly Gram-negative bacilli, antibiotics targeted at such bacteria should be preferred.