Tuberculous Abdomen 11062006
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Transcript of Tuberculous Abdomen 11062006
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Tuberculous Abdomen
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Definition
Tuberculous abdomen is a condition inwhich there is tuberculous infection of theperitoneum or other organs in theabdomen
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Robert Koch, a German Scientist who found outthe causative organism for consumption and
revealed his invention in1882
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Gram negative bacillusMycobacterium tuberculosis
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Ways of presentation Acute tuberculous peritonitis
Chronic tuberculous peritonitis
Tuberculous stricture of the intestine(small) causing subacute intestinalobstruction
Ileo caecal tuberculosis presenting with amass in the right iliac fossa
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Acute tuberculous peritonitis Acute abdomen with severepain
Acute inflammation of the peritoneum
Straw coloured fluid Tubercles in the greater omentum and
peritoneum
Tubercles may casseate Anti tuberculous treatment
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Chronic tuberculous peritonitis The condition presents with abdominal
pain
Fever
Loss of weight
Ascites
Nightsweats
Abdominalmass
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Origin of infection Tuberculous mesenteric lymph nodes
Tuberculosis of the ileocaecal region
Tuberculous pyosalpinx
Blood borne infection from pulmonarytuberculosis, usually the miliary but
occasionally the cavitating form
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Varieties of tuberculous peritonitis Ascitic form peritoneal fluid distension of
abdomen. Patient comes with the complaint of swelling
of the abdomen. increased abdominal pressureumbilical hernia, inguinal hernia
Purulent form
Rare usually secondary to tuberculous salpingitispockets of adherent intestines and omentum containingtuberculous pus. cold abscesses
Encysted form
Inflammation and ascites are confined to one part of theabdominal cavity
Fibrous form
Wide spread adhesions
adhesive obstruction
G
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GastrointestinalTuberculosis
Abdominal tuberculosis is usually secondary to
pulmonary tuberculosis, radiologic evaluation oftenshows no evidence of lung disease
Ileocecum and ColonThe ileocecal region is the most common area of
involvement in the gastrointestinal tract due to theabundance of lymphoid tissue.
The natural course of gastrointestinal tuberculosismay beulcerativehypertrophic orulcerohypertrophic.
G i i l T b l i
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Gastrointestinal Tuberculosis
Barium studies demonstrate spasm andhypermotility with edema of the ileocecal valve inthe early stages
Later thickening of the ileocecal valve.
A widely gaping ileocecal valve with narrowing
of the terminal ileum (Fleischner sign) A narrowed terminal ileum with rapidemptying
of the diseased segment through a gapingileocecal valve into a shortened, rigid,
obliterated cecum (Stierlin sign) Focal or diffuse aphthous ulcers : tend to be
linearorstellate, following the orientation oflymphoid follicles (ie, longitudinal in the terminal
ileum and transverse in the colon)
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Gastrointestinal Tuberculosis
In advanced cases,symmetric annularstenosis and obstructionassociated with shortening, retraction, andpouchformation may be seen.
The cecum becomes conical, shrunken,and retractedout of the iliac fossa due tofibrosis within the mesocolon,
Ileocecal valve becomes fixed, irregular,gaping, and incompetent
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Investigations Blood routine
Urine routine - to detect diabetes mellitus
Plain X-ray of the abdomen
Laparoscopy
Laparoscopicbiopsy of tubercles foun inthe peritoneum or other parts
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Treatment
Antituberculous treatmentdrugs : Akurit 4
Ripe Kit
isoniazid
rifampicin
pyrazinamide
ethambutol
Surgicalintervention as and whenneeded
C l i f M b t i
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Colonies of Mycobacterium
tuberculosisLowenstein-Jensen
med
Ch i l t b l i A h i t b l
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Chronic pulmonary tuberculosis.A chronic tuberculouscavity is seen in the apical-posterior segment of theright upper lobe. Peribronchial tubercles are present
throughout the remainder of the right lung.
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Circumferential ulceration is characteristic of
intestinal tuberculosis.
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TB is transmitted by airborne droplet nuclei,which may contain fewer than 10 bacilli.
Exposure to TB occurs by sharing commonairspace with a patient who is infectious. Wheninhaled, droplet nuclei are deposited within theterminal airspaces of the lung. Upon
encountering the bacilli, macrophages ingestand transport the bacteria to regional lymphnodes
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The bacilli have 4 potential fates:
(1) they may be killed by the immune system,
(2) they may multiply and cause primary TB,
(3) they may become dormant and remainasymptomatic, or
(4) they may proliferate after a latency period(reactivation disease). Reactivation disease mayoccur following either (2) or (3) above.
Gastrointestinal TB: Any site along the
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Gastrointestinal TB: Any site along thegastrointestinal tract may become infected.Symptoms are referable to the site infected,including the following:
nonhealing ulcers of the mouth or anus;
difficulty swallowing with esophageal disease;
abdominal pain mimicking peptic ulcer diseasewith stomach or duodenal infection;
malabsorption with infection of the smallintestine;
and pain, diarrhea, or hematochezia with
infection of the colon.
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Emaciation due to TB
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Tuberculosis of the skin
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Lupus vulgaris on the face of an 88 y-o female (gross findings).@Thefacial skin is the most common site of reinfection tuberculosis of this
form.
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Mantoux Test
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Mantoux positive
M i th i d ti M t t
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Measuring the induration Mx test
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Tuberculous ulcers in the intestine
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Bilateral Extensive Tuberculosis
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Tuberculouspneumonitic
patch
T b l
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Tuberculousinfiltration
withcavitation
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Tuberculouspneumonitis
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Tuberculousperitonitis
USGM Intestinesfloating inperitoneal
fluid - ascites
Mycobacterium tuberculosis Acid-fast stain
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Mycobacterium tuberculosis. Acid-fast stain
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Gram negative bacilli in sputum
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Caseation
L h i t ll
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Langhans giant cells
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Drugs used to treat TB disease. From left to rightisoniazid, rifampin, pyrazinamide, and ethambutol.
Streptomycin (not shown) is given by injection
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Gastrointestinal Tuberculosis: This is uncommontoday because routine pasteurization of milk haseliminated Mycobacterium bovis infections. However, M.
tuberculosis organisms coughed up in sputum may beswallowed into the GI tract. The classic lesions arecircumferential ulcerations with stricture of the smallintestine. There is a predilection for ileocecalinvolvement because of the abundant lymphoid tissue
and slower rate of passage of lumenal contents.
Scrofula: Tuberculous lymphadenitis of the cervicalnodes may produce a mass of firm, matted nodes just
under the mandible. There can be chronic drainingfistulous tracts to overlying skin. This complication mayappear in children, and Mycobacterium scrofulaceummay be cultured.
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The name tuberculosis comes from tubercles. These are
small, hard lumps that form when the immune systembuilds a wall around the TB bacteria in the lungs.
There are two kinds of active TB.
Primary TB occurs soon after a person is first exposedto TB.
Reactivation TB occurs in people who were previouslyexposed to TB. If their immune system is weakened, TBcan break out of the tubercles and cause active disease.Most of the cases of TB in people with HIV are due toreactivation of a previous TB infection.
Active TB can cause the following symptoms: coughingfor more than 3 weeks, weight loss, constant fatigue,night sweats, and fevers, especially in the evening
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