A 23-year-old man presents to the physician with abdominal distention and tenderness with no vomiting or diarrhea. Physical examination shows hepatosplenomegaly, bowl sounds are normal. On questioning the patient says that he traveled to eastern South America 1 year ago. Several weeks after returning from his trip, he remembers having fever, diarrhea, weight loss and funny looking stools. Ultrasonography shows ascites and hepatic periporal fibrosis. Which of the following is most likely responsible for this patient present symptoms? A. Appendicitis B. Bowl obstruction C. Enterocolitis D. Portal hypertension E. Ruptured viscus
I think the answer is portal hypertension since the patient has ascitis and fibrosis which indicates a chronic course. He has been to South America where after he had some sort of intestinal infection. Im guessing it was due to a parasite which later caused the liver problems.
The correct answer is D. Schistosomiasis is a helminthic disease with hepatic involvement. Schistosoma mansoni cercaria, which are commonly found in fresh waters of South America, penetrate the host’s skin, invade the peripheral vasculature, and eventually settle in the portal or pelvic venous vasculature. Several weeks following infection, patients may develop symptoms similar to the ones described, such as fever, diarrhea, and weight loss; the “funny looking stools” likely represent S. mansoni eggs. Chronic infection may eventually lead to portal hypertension and hepatosplenomegaly, leading in turn to ascites and eventually cirrhosis. In addition, the hepatosplenomegaly leads to esophageal varices, producing bleeding that can often be the first clinical sign.
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