血吸虫病与肝胆疾病

　　中国流行的血吸虫病主要为日本血吸虫感染，虫卵随患者粪便排出，在水中孵化出毛蚴，毛蚴钻入中间宿主钉螺发育成尾蚴后逸出水中。当人接触疫水，尾蚴即钻入皮肤或黏膜成为童虫，童虫经静脉或淋巴管进入右心至肺循环，再从体循环经毛细血管进门静脉最后入肝发育为成虫，寄生于门脉系统。钉螺是必需的中间宿主，人和家畜为终宿主。由虫卵所引起的复杂免疫病理反应是产生血吸虫病基本病变的主要原因。肝脏是血吸虫侵犯的主要脏器，虫卵随血流到达肝脏，沉积在肝内门静脉分支及入口形成肉芽肿，肉芽肿是本病的病理基础。

　　The prognosis of this disease is closely related to the degree of infection, the duration of the disease, age, the presence of complications, ectopic damage, and whether the treatment is timely and thorough. The main complications of this disease are as follows:

　　1. Upper gastrointestinal hemorrhage

　　It is an important complication in the late stage of patients, with an incidence rate of about 10%. The bleeding site is mostly the lower esophageal and fundus coronary veins. It is often induced by mechanical injury, overexertion, and so on, and manifested as hematemesis and black stools, with a generally large amount of bleeding.

　　2. Liver encephalopathy

　　The liver encephalopathy in the late stage of patients is mostly ascitic type, often induced by massive hemorrhage, large amounts of abdominal fluid drainage, and excessive diuresis.

　　3. Infection

　　Due to decreased immune function, hypoalbuminemia, portal hypertension, etc., patients are prone to complications such as viral hepatitis, typhoid fever, peritonitis, Salmonella infection, appendicitis, and so on.

　　4. Intestinal complications

　　Schistosomiasis can cause severe colonic lesions leading to intestinal stricture, which may complicate incomplete intestinal obstruction, most commonly in the sigmoid colon and rectum. Colonic granulomas in schistosomiasis patients may complicate colon cancer, mostly adenocarcinoma, with low malignancy.

　　During the acute stage, patients with this disease may have intermittent or remittent fever, cercarial dermatitis, urticaria, enlargement of the liver and spleen, abdominal pain, diarrhea, and enlargement of lymph nodes throughout the body. During the chronic stage, there are usually no obvious symptoms, and a few patients may have abdominal pain and diarrhea of unknown cause, and enlargement of the liver and spleen. If liver and biliary damage occurs, symptoms and signs of liver cirrhosis, portal hypertension, cholecystitis, and (or) cholangitis may appear.

　　The prevention of this disease lies in controlling the source of infection in the epidemic area, conducting a general survey and treatment of patients and sick animals every year. The key to preventing the disease is to cut off the transmission route and eliminate snails. Faeces must be treated in a harmless manner before use. Protect water sources, improve water use. Protect susceptible populations and strictly prohibit swimming and playing in epidemic water. When contacting epidemic water, protective clothing and pants should be worn, and anti-cercarial agents should be used.

　　Schistosomiasis is a serious parasitic disease that危害 human health, with a long history and widespread prevalence, leading to a series of liver and biliary diseases. The main examination methods are as follows.

　　1. Blood count: The main characteristic of peripheral blood in schistosomiasis patients during the acute stage is a significant increase in eosinophils, with the total white blood cell count above 10×10^9/L, and eosinophils generally accounting for 20% to 40%, with the highest reaching over 90%. Chronic schistosomiasis patients usually have a mild increase within 20%, while severe acute schistosomiasis patients often do not increase or even disappear. In the late stage, patients often have a decrease in red blood cells, white blood cells, and platelets due to hypersplenism.

　　2. Liver function tests: The serum globulin levels in acute schistosomiasis patients are elevated, with mild increases in serum ALT and AST. In the late stage, due to liver fibrosis, there is a decrease in serum albumin, an increase in globulin, and a common phenomenon of an inverted ratio of albumin to globulin. Liver function tests in chronic schistosomiasis patients, especially asymptomatic ones, are mostly normal.

　　3, Stool examination：The direct basis for diagnosing schistosomiasis is to check for eggs in the stool and to hatch out the cercariae, but the detection rate is generally high during the acute stage, while the positive rate of chronic and late-stage patients is not high, and the commonly used modified Kato-Katz thick smear method or egg transparency method is used to check for eggs.

　　4, Immunological examination:There are many methods, and they have high sensitivity and specificity. Blood collection is minimal and the operation is simple, but due to the long duration of antibodies in the patient's serum after cure, it is not possible to distinguish between past infections and current patients, and there are false positives and false negatives. In recent years, the microassay method of detecting patient circulating antigens with monoclonal antibodies may be possible to diagnose active infection and can be used as a reference for evaluating efficacy, and is the direction of development of immunological diagnosis.

　　5, B-ultrasound examination：Can judge the degree of liver fibrosis, visible changes in the size of the liver and spleen, the portal vein vessels become thickened and reticulated, and can be localized for liver puncture biopsy.

　　6, CT scan：Late-stage schistosomiasis patients often have calcification in the liver capsule and the portal vein area within the liver, CT scan can show specific images such as thickening and calcification of the liver capsule, and severe liver fibrosis can be manifested as a turtle-back-like image.

　　Patients with schistosomiasis should pay attention to a light diet and reasonable dietary搭配. It is advisable to eat high-protein, nutritious, vitamin and mineral-rich, high-calorie and easily digestible foods. It is forbidden to eat greasy and difficult-to-digest foods such as fried, smoked, grilled, cold, and刺激性 food, and it is also forbidden to eat high-salt and high-fat foods.

　　This disease is mainly caused by human contact with epidemic water. The adult worms mainly parasitize the portal venous system, and the complex immune pathological reactions caused by the deposition of eggs can lead to damage to multiple tissues and organs in the body. The following is the treatment method of traditional Chinese medicine for this disease:

　　Liver and gallbladder damp-heat syndrome

　　Symptoms:Persistent fever that does not subside, yellowing of the skin and conjunctiva, bright yellow, distension and pain in the right hypochondrium, palpable mass under the hypochondrium, or even abdominal distension like a drum, palpable fluid, red tongue, yellow greasy coating, wiry and rapid pulse.

　　Treatment Method:：Clear and relieve dampness in the liver and gallbladder.

　　Prescription:：甘露消毒丹，or茵陈四苓散

　　Usage:

　　Adjustments:Add赤芍、桃仁、牡蛎、丹参；for physical weakness, add 党参、黄芪.