Diagnosis of worms entering the bile duct by any medical technique?

The article is professionally consulted with Master, Doctor Tong Diu Huong - Radiologist - Department of Diagnostic Imaging - Vinmec Nha Trang International General Hospital.

In addition to clinical symptoms such as sudden severe abdominal pain in the position of the sternum and right lower ribs, protrusion of the buttocks, vomiting a lot, etc., in order to diagnose bile duct worms most accurately, the doctor will ask Ask the patient to do some paraclinical tests and diagnostic imaging tools.

Bile duct worm is a condition in which the worm travels backwards from the small intestine through the sphincter of Oddi into the bile duct. This condition is usually due to an excessive number of worms in the small intestine, leading to the worms entering the bile duct, because the nutrient source in the small intestine is not enough for the worms to multiply, so they have to move to other environments in the human body. .
Besides, the problem of unhygienic eating and drinking, the use of ineffective deworming drugs that make the worms survive and parasitize in the human intestinal system are also one of the main causes leading to worms. until the worm enters the bile duct. The ineffective use of deworming drugs also brings great harm, namely leading to movement disorders that cause the worms to move around, a high risk of entering the oddi sphincter and back up the common bile duct. , gallbladder and other bile ducts.
Another cause of worms entering the bile duct is that when gastric juice is excreted from the stomach, the acidity will be reduced, from which the environment in the intestinal system is no longer an ideal environment for worms. will move to other locations in the human body to find a more suitable environment.
For patients after partial gastric bypass surgery or infectious diseases, there is a high risk of worms entering the bile duct. The cause is due to changes in the endogenous environment in the digestive tract when eating is not hygienic and not deworming periodically.
Bile duct worms can occur at any age, but the disease is most common in children under 10 years of age and favorable factors that increase the likelihood of worms entering the bile ducts are a diet lacking in protein. , low acidity of gastric juice, infectious diseases as well as thin body.

When the worms enter the bile duct, the patient will appear some early symptoms as follows:
Sudden onset of severe abdominal pain in the liver, this pain is located next to the sternum and under the right flank, causing the patient to must be supported and children forced to carry it on their shoulders; Accompanied by sudden and severe pain, vomiting is profuse, in some cases, worms may be vomited. On clinical examination, there is a reaction in the right lower ribs, the position near the sternum is painful but the gallbladder and liver are normal, there are no signs of jaundice or yellow eyes, the general condition does not change significantly. In the case of worms entering the bile duct, the infection stage of the biliary tract will cause the following symptoms to the patient:
After a week of sudden severe pain, buttocks, the patient often has symptoms of systemic infection with fever. The pain fluctuates from 38 degrees Celsius to 39 degrees Celsius. The pain is somewhat reduced, but the right lower quadrant is still painful, the gallbladder is not painful and full, the patient will be tired and eat poorly, leading to rapid weight loss. The patient's skin and mucous membranes are not yellow or in some cases mildly yellow. In the case of worms entering the bile duct, if not treated, it will lead to liver abscess, causing some of the following symptoms for the patient:
The patient shows signs of severe infection throughout the body, pale skin, thin and weak. and blood tests showed anemia. Dull pain in the liver, mild yellow skin and mucous membranes, signs of hepatomegaly below the costal margin or upward, pressing on the liver is very painful, using a positive liver vibration test. Due to a systemic infection, the patient has a high fever from 39 degrees Celsius to 40 degrees Celsius, shivers and poor appetite due to dull pain.

In addition to the above clinical symptoms, in order to diagnose bile duct worms most accurately, the doctor will ask the patient to do some subclinical tests and imaging tools as follows: Blood count : A complete blood count test will show a predominance of polymorphonuclear leukocytes, elevated white blood cells because this is an indicator of infection. Bilirubin will be elevated if there is biliary obstruction. The Bilan test was positive for infection with elevated erythrocyte sedimentation rate and CRP. Liver enzyme tests are within normal values ​​to differentiate from causes of biliary obstruction due to some liver diseases. Abdominal X-ray: This imaging technique is intended to make it easier for the physician to distinguish between the causes of acute abdominal pain. Contrast-enhanced cholangiography: This is a diagnostic technique for bile duct worms often prescribed by doctors. With this technique, it will be possible to detect images of adult worms or gallstones causing biliary obstruction in patients. Abdominal ultrasound: When abdominal ultrasound will help doctors observe indirect images reflecting abnormalities in the biliary system. For example, the common bile duct lumen has the most immobile echogenicity or the common hepatic duct is dilated. Cholangioscopy: This is the most accurate method and especially this technique has both diagnostic and therapeutic roles, because the gun can be removed through the endoscope system.

Complications when worms enter the bile ducts can cause infection of the bile ducts, abscesses of the bile ducts and liver. Therefore, when the symptoms of worms in the bile duct become more severe or the above complications appear, the doctor will appoint biliary tract surgery with the aim of removing the worms and draining the biliary tract.
However, when it is uncertain whether there are worms in the bile duct or supportive treatment after surgery to remove worms, the doctor will prescribe medical treatment with drugs as follows:
Use a smooth muscle relaxant (sphincter of Oddi) ) such as: A-tropin, Ami-nazin... Using diuretics and increasing bile secretion to support treatment such as: Secretin, Bilifluine... Using deworming drugs Fugacar, Albendazole or Meben-dazole.. Bile duct worms will cause a number of dangerous complications, therefore, to prevent the disease, it is advisable to follow a reasonable and hygienic diet, eat cooked food, drink boiling water, and minimize the risk of diseases. Rare or salad foods and raw vegetables in daily meals to protect the health of individuals and family members.
At the same time, it is recommended to deworm every 6 months to prevent diseases related to worms. When noticing signs and symptoms similar to bile duct worms, it is best for the patient to go to a medical facility to be diagnosed with bile duct worms and treated promptly, thereby improving the effectiveness of treatment. treat.
Patients need to go to a reputable hospital to conduct examination and treatment as soon as there are signs of bile duct worms. Currently, Vinmec International General Hospital is one of the leading prestigious hospitals in the country, trusted by a large number of patients for medical examination and treatment. Not only the physical system, modern equipment: 6 ultrasound rooms, 4 DR X-ray rooms (1 full-axis machine, 1 light machine, 1 general machine and 1 mammography machine) , 2 DR portable X-ray machines, 2 multi-row CT scanner rooms (1 128 rows and 1 16 arrays), 2 Magnetic resonance imaging rooms (1 3 Tesla and 1 1.5 Tesla), 1 room for 2 levels of interventional angiography and 1 room to measure bone mineral density.... Vinmec is also the place to gather a team of experienced doctors and nurses who will greatly assist in diagnosis and detection. early signs of abnormality in the patient's body. In particular, with a space designed according to 5-star hotel standards, Vinmec ensures to bring the patient the most comfort, friendliness and peace of mind.