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Pathophysiology Diagram:

Predisposing

factors:

Environment

Precipitating

factors:

AlcoholismContact with infested

Schistosomal cercaria attach

to the skin and penetrate

Transformation from a free-living

infective stage to a parasitic larval

Once through the dermis, they locate

schistosomula are carried to the first capillary bed, thelungs, where they become lodged and double in size

The larvae then make their way to the

Worms mature and paired adults migrate out of the

liver to the mesenteries where the female begins laying

The eggs pass through the walls of the mesenteriesand through the intestinal walls into the gut lumen and

Not all the eggs pass out via the intestine. Many

of the eggs are swept back to the liver where

Lodged in the liver

host inflammatory

response activates in

Eggs become surrounded by a dense infiltrate composed of mainly

lymphocytes, macrophages and a variable number of eosinophils, held

Large florid lesions are produced as an early

Release of SEA - soluble egg

skin rashes

asthma-like

episodes fever

malaise

diarrhea

swollen lymphnodes

Hepatocyte

Fever

Pain

Anorexia

Fatigue

Nausea and

vomiting

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Liver

Ischemia and necrosis of liver

Alteration in blood and lymph

Decreased

estrogen

Atrophi

c

Menstru

al

Presinusoidal

obstruction caused byReduced ability of

the liver to

synthesize normal

Increasedresistance to flow

within the portal

Increased

portal

Congestion of

lymph channels

Damage to

the spleen

Increased

inflow beyond

the capacity

of the

compliant

Spleen

Lysis of blood

Decreased

platelet

DecreasedHgbcount=10.1g/

ANEMIBleeding

Plasma leaks into

the peritoneal

Loss of plasma

proteins into

the ascitic fluid

Decreased ability of

the vascular system

to hold or collect

Reduced oncotic

pressure in the

vascular

Kidneys increases

the secretions of

PLEURAL

EFFUSION on the

HYPOALBUMINEM

Circulating blood

volume decreases

from the loss of

osmotic pressure

Liver unable to

inactivate

aldosterone due to

Sodium and water

retention

continues adding

more volume to

ASCITES;

abdominal girth

of=105 cm in

diameter