Pathophysiology Diagram: Predisposing factors: Environment Contact with infested water Schistosomal cercaria attach to the skin and

penetrate the epidermis Transformation from a free-living infective stage to a parasitic larval schistosomulum Once through the dermis, they locate a venule schistosomula are carried to the first capillary bed, the lungs, where they become lodged and double in size over the next few days The larvae then make their way to the liver Worms mature and paired adults migrate out of the liver to the mesenteries where the female begins laying eggs The eggs pass through the walls of the mesenteries and through the intestinal walls into the gut lumen and are excreted Not all the eggs pass out via the intestine. Many of the eggs are swept back to the liver where they are trapped Lodged in the liver parenchyma Release of SEA - soluble egg antigens host inflammatory response activates in Precipitating factors: Alcoholism

• skin rashes • asthma-like episodes • fever • malaise • diarrhea • swollen lymph nodes

Eggs become surrounded by a dense infiltrate composed of mainly lymphocytes, macrophages and a variable number of eosinophils, held together in an extracellular matrix Large florid lesions are produced as an early peak reactivity

• • • • •

Fever Pain Anorexia Fatigue Nausea and vomiting

Hepatocyte Damage

Liver Inflammation Alteration in blood and lymph flow Ischemia and necrosis of liver cells Presinusoidal obstruction caused by schistosoma Decreased estrogen detoxification Atrophi c uterine Increased portal pressure Menstru al changes Congestion of lymph channels occur Plasma leaks into the peritoneal cavity Loss of plasma proteins into the ascitic fluid HYPOALBUMINEM IA Reduced ability of the liver to synthesize normal amounts of albumin

Increased resistance to flow within the portal venous system

Increased inflow beyond the capacity of the compliant portal vessels

Damage to the spleen occurs

Reduced oncotic pressure in the vascular compartment Decreased ability of the vascular system to hold or collect water Circulating blood volume decreases from the loss of osmotic pressure

PLEURAL EFFUSION on the left base Kidneys increases the secretions of aldosterone Liver unable to inactivate aldosterone due to hepatocellular Sodium and water retention continues adding more volume to the ascitic fluid ASCITES; abdominal girth of=105 cm in diameter

Spleen enlarges

Lysis of blood cells Decreased Hgb count=10.1g/ L ANEMI A Decreased platelet count=105 Bleeding

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