Pathophysiology Diagram:

Predisposing Precipitating
factors: factors:
Contact with infested
Environment water Alcoholism

Schistosomal cercaria attach

to the skin and penetrate
the epidermis

Transformation from a free-living

infective stage to a parasitic larval
schistosomulum

Once through the dermis, they locate

a venule

schistosomula are carried to the first capillary bed, the

lungs, where they become lodged and double in size
over the next few days

The larvae then make their way to the

liver

Worms mature and paired adults migrate out of the

liver to the mesenteries where the female begins laying
eggs

The eggs pass through the walls of the mesenteries

and through the intestinal walls into the gut lumen and
are excreted

Not all the eggs pass out via the intestine. Many
of the eggs are swept back to the liver where
they are trapped

Lodged in the liver

parenchyma
• skin rashes
Release of SEA - soluble egg • asthma-like
antigens episodes
• fever
host inflammatory • malaise
response activates in • diarrhea
• swollen lymph
nodes

Eggs become surrounded by a dense infiltrate composed of mainly

lymphocytes, macrophages and a variable number of eosinophils, held
together in an extracellular matrix

Large florid lesions are produced as an early

peak reactivity

• Fever
• Pain
• Anorexia
• Fatigue
• Nausea and Hepatocyte
vomiting Damage
 Liver
Inflammation

Alteration in blood and lymph

flow

Ischemia and necrosis of liver

cells

Presinusoidal Decreased Reduced ability of

obstruction caused by estrogen the liver to
schistosoma detoxification synthesize normal
amounts of albumin
Atrophi Menstru
c al
Increased uterine changes
resistance to flow Increased Congestion of
within the portal portal lymph channels
venous system pressure occur
Plasma leaks into
the peritoneal
Increased cavity
inflow beyond
Loss of plasma
the capacity HYPOALBUMINEM
proteins into
of the IA
the ascitic fluid
compliant
portal vessels
Reduced oncotic
pressure in the PLEURAL
Damage to vascular EFFUSION on the
the spleen compartment left base
occurs
Decreased ability of
Kidneys increases
the vascular system
Spleen the secretions of
to hold or collect
enlarges aldosterone
water
Liver unable to
Circulating blood inactivate
volume decreases aldosterone due to
Lysis of blood from the loss of hepatocellular
cells osmotic pressure
Sodium and water
Decreased Decreased retention
Hgb continues adding
platelet
count=10.1g/ more volume to
L count=105
the ascitic fluid
Bleeding
ANEMI
ASCITES;
A
abdominal girth
of=105 cm in
diameter