Tuberculous Abdomen 11062006

8/2/2019 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.
http://www.yamagiku.co.jp/pathology/photo/photo163-3.htm


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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
http://www.emedicine.com/med/images/2324Dsc00001.jpg


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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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Tuberculous Abdomen 11062006