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Intestinal Tuberculosis
Second Affiliated hospitalYan Chen
Second Affiliated hospitalYan Chen
Intestinal tuberculosis
General situation
Etiology and pathogenesis
Pathology
Clinical manifestation
lab & other examination
Diagnosis and differential diagnosis
Treatment , prognosis and prevention
General ideasDeveloping countries (95%), especially poverty,
malnutrition, overcrowding and HIV coinfection.
Involvement of intestine is usually secondary to pulmonary tuberculosis.
The ileocecal region is the most common area of involvement in the intestinal tract .
Why ?
The abundance of
lymphoid tissue Long residence time
of bactera in ileocucum
The ileocecal region is the most common area of involvement in the intestinal tract .
Why ?
The abundance of
lymphoid tissue Long residence time
of bactera in ileocucum
Predisposing factors
Fatigue
poor sanitation
malnutrition
lowered resistance etc.
Pathogenic organism----tubercle bacillus
tubercle bacillus maybe either the human type or bovine type
human type----90%
bovine type----10%
Etiology and pathogenesis
Route of transmission
Propagation by mouth:
Hemotogenous dissemination: miliary TB
Spread straightly:
Bacilium: number, virulence
Decreased immunity of human
Weakening of intestinal resistance
Etiology and pathogenesis Etiology and pathogenesis
Caseation
Langhan’s giant cells
Clinical manifestation Systemic symptoms
● Fatigue
● low-grade fever
● Night sweats
● Loss of weight
● poor appetite
● anemia
Local symptoms
● abdominal distension
● ascites
● mass
● abdominal pain
● diarrhea & constipation
● complication
Local symptoms
● abdominal distension
● ascites
● mass
● abdominal pain
● diarrhea & constipation
● complication
Extraintestinal tuberculosis manifestation : pulmanory TBExtraintestinal tuberculosis manifestation : pulmanory TB
Cachexia
laboratory findingslaboratory findings
erythrocyte sedimentation rate, ESR
● ESR typically elevated in the active stage
● Stool routine test : occult blood
laboratory findingslaboratory findings
PPD test
purified protein derivative
tuberculin skin test
culture or histological examination of specimen
biopsy-microscopic tissue exam revealed tubercular histological feature of TB
PPD test
purified protein derivative
tuberculin skin test
culture or histological examination of specimen
biopsy-microscopic tissue exam revealed tubercular histological feature of TB
Straight arrow show Conical and shrunken cecum;curved arrow show the narrowing of the terminal ileum
RadiographyRadiography In advanced cases, symmetric annular stenosis
and obstruction associated with shortening, retraction, and pouch formation may be seen. The cecum becomes conical, shrunken, and retracted out of the iliac fossa due to fibrosis within the mesocolon, Ileocecal valve becomes fixed, irregular, gaping, and incompeten
In advanced cases, symmetric annular stenosis and obstruction associated with shortening, retraction, and pouch formation may be seen. The cecum becomes conical, shrunken, and retracted out of the iliac fossa due to fibrosis within the mesocolon, Ileocecal valve becomes fixed, irregular, gaping, and incompeten
TB
Colonoscopy
Colonoscopy
Ulceration
TB
TB
Imaging featuresUltrasonography, CT, MRI
Asymmetric bowel wall thickening
Ascites
Inflammatory mass of bowel wall
Narrowing of the terminal ileum with thickening and gaping of the iliocaecal valve
Fluid surrounding bowel caused by inflammation of the bowel wall
Other examinationsLaparoscopic biopsy of tubercles found in
the peritoneum or other parts
Laparotomy
Capsule endoscopy
enteroscopy
Diagnosis & differential diagnosis
Younger patients presented with extraintestinal TB
Symptom: toxic symptom
diarrhea, abdominal pain, abdominal mass
X-ray: sterlin sign, stricture of bowel, deformation
Colonoscopy and biopsy: inflammation,ulcer,polyp,striction
caseating granuloma, bacterium(+)
PPD test :strongly positive
Exploratory laparotomy for patients difficult to be diagnosed
Experimental treatment :2-8 weeks
Diagnostic criteria
Diagnostic criteria
Diagnosis & differential diagnosisDiagnosis & differential diagnosis
Differential diagnosis Crohn’s disease: The major diagnostic dilemma of ITB is to
differentiate it from CD. Right-sided colonic carcinoma Amoebiasis or schistosomic granuloma Chronic bacillary Dysentery or cholera Malignant lymphoma FGID:IBS, functional diarrhea
Differential diagnosis Crohn’s disease: The major diagnostic dilemma of ITB is to
differentiate it from CD. Right-sided colonic carcinoma Amoebiasis or schistosomic granuloma Chronic bacillary Dysentery or cholera Malignant lymphoma FGID:IBS, functional diarrhea
TB & CDTB & CD
TB CD Extraintestinal TB √ Course(relief and relapse) √ Fistula/abscess/peri-anal lesion √ Segmental appearance √ Form of ulcer transverse longitudinal
Caseating granuloma by biopsy √ PPD test with strong positive √
Effective Anti-TB treatment √
TB CD Extraintestinal TB √ Course(relief and relapse) √ Fistula/abscess/peri-anal lesion √ Segmental appearance √ Form of ulcer transverse longitudinal
Caseating granuloma by biopsy √ PPD test with strong positive √
Effective Anti-TB treatment √
Female
19 years old
Right lower quadrant pain and fever
The ileocecal region
Sigmoid and Rectom
After treatmentAfter treatment
Treatment purpose: resolve symptom, improve constitutional condition,
promote curing, prevent complication
Measures: rest
nutritional support
anti-TB chemotherapy
relieve symptom
surgery
tuberculous peritonitisSame as tuberculous pleurisy