Parasitic disease of the liver and biliary tree

Several parasites infest liver or biliary tree, either during their maturation stages or as adult worms. biliary tree parasites may cause pancreatitis, cholecystitis, biliary tree obstruction, recurrent cholangitis, biliaiy tree strictures and some may lead to cholangiocarcinoma. This review discusses the hepatobilialy parasites, and shows our experience in diagnosis and management of these parasites. Ultrasonography of the liver is diagnostic in schistosomiasis, hydatid cysts, amebic liver abscess, ascariasis and other biliary tree parasites showing bile duct dilatation. Percutaneous aspiration under ultrasonography guidance of hydatid liver cysts or amebic abscess are effective measures in management. Endoscopic retrograde cholangiopancreatography [ERCP] is safe and effective in diagnosis and management of biliary tree parasites

Alimentary tract presentations of brucellosis

A retrospective study was conducted to assess alimentary tract involvement in 140 Saudi patients with acute or chronic brucellosis. A brucella standard agglutination titer o 160 or over was considered to be positive evidence of brucella infection. The commonest symptoms were anorexia, weight loss, right hypochondrial pain, and constipation. A history of raw milk ingestion was obtained in 38 patients. Thirty-nine patients had hepatomegaly, 21 had splenomegaly, and six had signs of cholecystitis. Bilirubin was elevated in eight patients; one or more of liver enzyme activities studied were elevated in 75 patients. Four of the 14 liver biopsies performed revealed Brucella microgranulomata. Abdominal ultrasound studies were abnormal in 29 of 46 patients. Thirty patients had a normal upper or lower gastrointestinal tract endoscopy. Blood cultures from 18 patients were incubated for six to eight weeks, with Brucella melitensis isolated from five. Sixty-seven patients [4.86%] received effective treatment for hrucellosis with improvement in the symptoms, signs and liver functions. Brucellosis is relatively common in the Kingdom of Saudi Arabia, and efforts should be taken to control and possibly eradicate this disease