Liver: Portal System Infection

Pylephlebitis

Basics

  • Infective Suppurative Thrombosis of the Portal Vein
  • Cause: Intraabdominal Infection Causes Local Thrombophlebitis & Extends into Portal System
    • Most Common Sources: Appendicitis or Diverticulitis

Presentation

  • Symptoms: Fever & Abdominal Pain
  • Complications:
    • Extend into Mesenteric Veins Causing Bowel Ischemia
    • Pyogenic Liver Abscess
    • Portal HTN

Diagnosis

  • Dx: CT (Portal Vein Thrombosis/Gas) & Blood Cx

Treatment

  • Tx: IV ABX, Anticoagulation & Remove Infected Source (Appendectomy, etc.)

Schistosomiasis

Basics

  • Parasite: Schistosoma
  • Generally Seen in Migrants/Travelers From Endemic Areas (Sub-Saharan Africa)

Presentation

  • Acute Presentation:
    • Swimmer’s Itch & Maculopapular Rash
    • Katayama Syndrome (Systemic Hypersensitivity Reaction)
  • Chronic Presentation:
    • Bowel Ulceration/Scarring
    • Periportal Fibrosis – Most Common Cause of Presinusoidal Portal Hypertension
    • Neuroschistosomiasis
    • Bladder Granulomatous Inflammation & Urinary Tract Obstruction

Diagnosis

  • Dx: Serology

Treatment

  • Tx: Praziquantel
  • If Develops Hepatic Fibrosis & Portal Hypertension: Portosystemic Shunt or Esophagogastric Devascularization with Splenectomy

Schistosoma 1

Schistosoma Egg 2

References

  1. Mebius MM, van Genderen PJ, Urbanus RT, Tielens AG, de Groot PG, van Hellemond JJ. Interference with the host haemostatic system by schistosomes. PLoS Pathog. 2013;9(12):e1003781. (License: CC BY-4.0)
  2. Chen MG. Assessment of morbidity due to Schistosoma japonicum infection in China. Infect Dis Poverty. 2014 Feb 14;3(1):6. (License: CC BY-2.0)