Liver fluke disease

　　The adult liver flukes mainly寄生在 humans or mammals (such as cats, dogs, pigs, rats) in the bile ducts of the liver and gallbladder. In the epidemic area, people or animals suffering from the disease often excrete eggs with bile into the intestines and mix them with feces to be excreted from the body. The eggs are ingested by the first intermediate host, the snail or the marsh snail, and hatch into miracidia in the digestive tract. After a series of developments and reproductions, such as the trophozoite and cercaria, they finally form many cercariae. The mature cercariae escape from the tail of the snail, swim in the water, and when they encounter the second intermediate host, freshwater fish or shrimp, they invade the body to form metacercariae, which are infectious.

　　In the epidemic area, the first intermediate host of this worm, the snail and the intermediate host, the Cyprinidae fish and small杂 fish, live in the same water body, and fish farming with human and animal feces is common, such as pouring human and animal feces into fish ponds or building toilets on fish ponds, which can cause a large number of fish infections. The metacercariae have a strong resistance to condiments, and can survive for 5 hours in soy sauce (containing 19.3% sodium chloride) and for 2 hours in vinegar (containing 3.36% acetic acid) before dying. Therefore, those who eat raw fish will easily be infected with the disease after adding condiments to the raw fish slices and eating them raw. A fish slice with a thickness of 1mm containing metacercariae will have all the metacercariae die within 1 second or 10 seconds in water at 90℃ and 60℃ respectively. Therefore, when eating 'fish rice porridge', if the raw fish slices are cut thicker or there are more slices, the temperature of the porridge will drop after being added, making it difficult to kill the metacercariae. Small fish that have been grilled but the internal fish meat is not fully cooked cannot kill the metacercariae, and people who eat such food are more likely to be infected with the disease. As for those who eat raw fish and shrimp, the possibility of infection is even greater.

　　It may be associated with the following diseases: bile duct obstruction (with fatigue, weight loss, jaundice, low fever, loss of appetite, which may be gallbladder tumor, bile duct obstruction with right upper quadrant colic pain and radiation to the shoulder and back, nausea and vomiting (worse after eating), aversion to oil, etc., which is common in gallstones. Of course, the cause of bile duct obstruction may also be liver or pancreatic disease.), bile stasis, pancreatitis.

　　The clinical symptoms of patients with clonorchiasis vary with the severity of infection. Patients with mild infection may have no symptoms. When non-epidemic area residents are infected with a large amount of infection for the first time, the human body's reaction is often very significant, and patients may experience fever, fatigue, jaundice, pain in the liver area, and enlargement of the liver with tenderness. Chronic and repeated infections in residents of epidemic areas may have symptoms such as loss of appetite, poor digestion, abdominal pain, diarrhea, fatigue, malnutrition, jaundice, and enlargement of the liver. A few long-term severe and repeated infected individuals may eventually develop into biliary cirrhosis. When the adult worms migrate to the common bile duct, they can cause biliary colic and obstructive jaundice.

　　The main route of transmission of clonorchiasis is food-borne. Therefore, in the epidemic area, publicize the transmission routes of the disease, make the masses understand the transmission routes of the disease, change bad eating habits, do not eat raw or half-cooked fish and shrimp; after the knife is used to cut raw fish, it must be washed clean before cutting cooked meat to avoid infection of metacercariae; strengthen fecal management, do not use human or cat, dog, pig and other feces that have not been treated to fertilize or feed fish and shrimp, to prevent fecal pollution of water sources and fish ponds; prohibit the sale of raw fish and 'raw fish congee' food and feed dogs, cats and other animals with raw fish scales, fish viscera, etc.; carry out general health examination and treatment of patients, investigate the reservoir hosts, and adopt killing, treatment or management according to the different economic value of the reservoir hosts. As long as the above measures can be effectively implemented, it is not difficult to achieve the goal of eliminating clonorchiasis. Do a good job in health education and publicity to improve the masses' understanding of the transmission routes of the disease, consciously not eating raw or undercooked fish and shrimp, improving cooking methods and changing eating habits, paying attention to separate the use of knives, chopping boards and utensils for raw and cooked foods, and not feeding raw fish to cats and dogs. Actively treating patients and carriers is an active measure to protect people's health and reduce the source of infection. The current treatment drugs, such as praziquantel (Praziquantel), are the first choice. Reasonable treatment of feces, changing the habit of fish farming are all important measures to prevent the transmission of Clonorchis sinensis. In addition, it is necessary to clean the pond mud and disinfect the fish pond, which has a certain effect on killing snails.

　　1. Pathogen examination:Eosinophilic granulocytes are increased. Eggshells are found in feces or duodenal drainage fluid. The positive rate of skin test with adult worm antigens, indirect red blood cell agglutination test, and enzyme-linked immunosorbent assay is high. The detection of eggshells is the main basis for diagnosis. Because the eggshells are small, the direct smear method of feces is prone to miss detection, so the collection method (such as water washing centrifugal sedimentation method, ether sedimentation method, etc.) and duodenal drainage bile for centrifugal sedimentation examination are often used. The eggshells of this worm are similar to those of the heterophyid eggs, and it is not easy to distinguish them.

　　2, Ultrasound imaging:The liver does not increase in size, and it can be seen that the wall of each branch of the intrahepatic bile duct and portal venous system is only surrounded by echo enhancement and thickening, presenting a kind of 'woolly' or 'worm-like' strong echo invading the liver substance.

　　One, Unsuitable Foods:Fresh freshwater fish and shrimp, do not separate raw and cooked foods when handling, nematode cysts can be contaminated through cutting boards, knives, chopsticks, and other utensils, sashimi, yakiniku, and flavored fish porridge. Foods with high fiber content and foods that produce a lot of gas, such as celery, chives, soybean sprouts, sweet potatoes, and dried beans. Alcohol and all spicy and刺激性 foods.

　　Two, Suitable Foods:Low-fat foods such as mixed grain porridge, buckwheat flour, taro, starchy dishes such as steamed sweet potatoes, sweet corn, potatoes, etc., drinks containing vinegar such as Tiandi Yi Hao, low-fat, low-cholesterol diet, eat more foods rich in zinc and magnesium, vitamin C, and eat light, soft, easy to digest, and non-irritating foods.

　　Three, Food Therapy

　　1, Black sesame Poria cocos gruel:Black sesame 10 grams, Poria cocos 15 grams, ginger 3 slices, rice 100 grams. Cut the ginger into slices, crush the Poria cocos, soak for half an hour, and decoct the medicine juice. Decoct twice and mix the two batches of juice. Then cook the mixed juice with rice and sesame seeds to make a thin gruel.

　　2, Lily bulb porridge:Lily bulb 60 grams, rice 100 grams, ginger 3 slices. Clean and chop the lily bulb, cook it with rice to make porridge.

　　3, Lotus leaf medicine seed duck soup:Lotus leaf 50 grams, fresh duck meat 500 grams, medicine seeds 100 grams. Clean and chop the fresh duck meat into pieces, mix it with the medicine seeds and lotus leaves, and cook with water until the meat is soft. No salt or other seasonings are added. Take 250 milliliters twice a day, for 10-14 days, which has the effects of diuresis and edema reduction, and invigorating the blood and promoting diuresis.

　　4, Herba Lysimachiae porridge:Herba Lysimachiae 10 grams, glutinous rice 50-100 grams. First, clean the herb, decoct the water, remove the residue, and then add glutinous rice to cook porridge.

　　5, Red bean winter melon crucian carp soup:Fresh crucian carp about 500 grams, red bean 100 grams, winter melon 200 grams. After the fresh crucian carp is scaled and the internal organs are removed, cook it with the red bean until half-cooked, then add 200 grams of winter melon, and continue to cook until the meat is soft and the soup is clear. No salt or other seasonings are added. After cooking, filter the residue with a cheesecloth. Take 250 milliliters twice a day, for 10-14 days. It can increase plasma protein and has a strong diuretic and edema-reducing effect.

　　6, Steamed watermelon with garlic:Garlic 60-90 grams, watermelon 1 piece, about 1500-2000 grams. First, use a sharp knife to dig a triangular hole on the watermelon skin, peel the garlic and put it inside the watermelon, then use the removed watermelon skin to block the hole, and steam it with the hole facing up. Eat the garlic and watermelon flesh while hot. Garlic has antibacterial and anti-inflammatory effects, while watermelon has the functions of heat dissipation, summer heat relief, and diuresis to reduce swelling.

　　7. Steamed frog:250 grams of frog, 3 grams of scallion whites, and 3 grams of ginger. Peel and remove the internal organs of the frog, place it in a bowl, add an appropriate amount of water, add rice wine, scallions, ginger, and a little salt, and boil it over high heat until it is tender. Drink the soup and eat it. It has the effect of replenishing deficiency and promoting diuresis.

　　8. Wolfberry and date fried egg:10 dates, 30 grams of western wolfberry, and 2 eggs. Wash the wolfberry and dates, add an appropriate amount of water, stew for 1 hour, and then add the eggs and boil for a few minutes. Make a fried egg. Take it twice a day, drink the soup and eat the egg. It is used for nourishing the liver and kidney.

　　9. Yam and longan stewed turtle:30 grams of yam slices, 20 grams of longan meat, and one turtle (about 500 grams). First, heat the turtle in a 45℃ warm water to make it urinate, then scald it to remove the intestines and claws; then add the turtle and meat with an appropriate amount of water, and stew with yam and longan meat until they are tender. Drink the soup and eat the meat. It is suitable for people with Yin deficiency.

　　10. Polygonum multiflorum and date boiled eggs:First, take 20 grams ofPolygonum multiflorum, 10 dates, and 2 eggs. Boil Polygonum multiflorum, dates, and eggs with an appropriate amount of water, remove the shell after the eggs are cooked, and then boil again. Boil the decoction to one bowl, remove the medicine residue, and then season it. Take it once a day, drink the soup and eat the egg, and take it for 15 to 20 days. It can protect the liver and stomach.

　　Etiological Treatment

　　1. Praziquantel has high efficacy, a short course of treatment, and mild side effects, and is the first choice for treating this disease. The total dose is determined according to the severity of the infection, and for mild cases, a 5-day therapy of 75mg/kg or 210mg/kg can be used.

　　2. Microfine capsule of nitrilotriazole 3-6um, total dose of 6-8mg./kg, divided into 3-5 equal parts, 1 part per day. This drug has many side effects, and a few may experience jaundice. Jaundice due to various reasons, recovery from acute or chronic hepatitis for less than one year, those with a history of mental illness, pregnant and lactating women, and those engaged in high-altitude work and driving are prohibited from using this drug.

　　3. Hexachlorodiphenyl (Blood Prevention 846) dry powder type 50-70mg/kg per day, taken all at once or divided into 2 doses, taken for 5-7 days as a course of treatment, the total dose for adults is generally 17.5g. This drug has a slow metabolism and excretion, certain side effects and delayed reactions, and some patients may experience liver function damage, toxic psychosis, and hemolytic reactions. Therefore, those with a history of the above conditions, severe neuroses, and hemoglobinopathies should avoid taking this medicine, and nitrilotriazole and hexachlorodiphenyl are now rarely used.