内科学教学课件：Intestinal tuberculosis Tuberculous
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Chapter 6
Intestinal tuberculosis &
Tuberculous peritonitis
Section Ⅰ Intestinal tuberculosis
Mycobacterium tuberculosis caused special infection of intestine
.
Etiology & Pathogenesis
• Pathogen is Mycobacterium tuberculosis • Routes of infection：
oral ，swallow infected sputum , main route
blood，miliary tuberculosis； surrounding spread，peritoneal, pelvic cavity
1. abdominal pain 2. Diarrhea and constipation 3. Palpable mass
4. systemic and extra bowel symptoms
fever night sweats weight loss, Anemia
Malnutrition Pulmonary TB
X-ray test
Barium meal or enema Irritable sign （ Stierlin sign ） ， Ulceration, Nodular thickening of mucosal folds, Short annular strictures
CT Enterography,CTE MRE
Complication
• Obstruction • Fistulization or penetration • Intestinal hemorrhage • Perforation
Laboratory test
blood ：anemia ，ESR↑ tuberculin test：PPD/T-spot
2.Hypertrophic form • Commonly in cecum • granuloma , fiber hyperproliferation→ a rigid thickening of the பைடு நூலகம்owel wall→
Strictures → obstruction
Pathology
Pathology
according to the balance between the bacterium and patient immune
• Exudation • Caseation • Ulceration • Hypertrophy
Pathology
1.Ulcerative form
Diagnosis
1. Abdominal symptom of TB + toxemia of TB 2. X-ray 3. Endoscopy 4. extra bowel TB & PPD / T-spot
• Therapeutic trial of antituberculosis treatment for 2~6 weeks
Etiology & Pathogenesis
Why Ileocecal region is a common TB site : 1. a long stasis
2. abundant lymphatic tissue
Pathogenesis: Infection of TB ＋ strong toxicity ＋ large amount ＋ weakened immune condition ＋ reduced local resistibility
• Laparotomy
inflammation of bowel wall and regional lymph tissue
↓
caseous necrosis
↓ ulceration
↓ extensive fibrosis
↓ Strictures and fistulae
Pathology
1.Ulcerative form
irritable bowel condition
Clinic features
1. abdominal pain 2. Diarrhea and constipation 3. Palpable mass Hypertrophic type in the right iliac fossa
Clinic features
Endoscopy
Congestion, Edema Ulceration perpendicular to the long axis of the bowel inflammatory polyps stricture caseating granulomas
endoscopy
• Endoscopie Capsulaire • Enteroscopy
1.Ulcerative form
2.Hypertrophic form 3.Ulcerohypertrophic form
a subtype ， a combination of features of the ulcerative and hypertrophic forms.
Clinic features
1. abdominal pain right iliac fossa(髂窝） pain
referred pain of superior belly or peripheral umbilicus ； tenderness in that region
Clinic features
1. abdominal pain 2. Diarrhea and constipation • Diarrhea : ulcerative type • Constipation: hypertrophic type • Diarrhea alternated with constipation:
Intestinal tuberculosis &
Tuberculous peritonitis
Section Ⅰ Intestinal tuberculosis
Mycobacterium tuberculosis caused special infection of intestine
.
Etiology & Pathogenesis
• Pathogen is Mycobacterium tuberculosis • Routes of infection：
oral ，swallow infected sputum , main route
blood，miliary tuberculosis； surrounding spread，peritoneal, pelvic cavity
1. abdominal pain 2. Diarrhea and constipation 3. Palpable mass
4. systemic and extra bowel symptoms
fever night sweats weight loss, Anemia
Malnutrition Pulmonary TB
X-ray test
Barium meal or enema Irritable sign （ Stierlin sign ） ， Ulceration, Nodular thickening of mucosal folds, Short annular strictures
CT Enterography,CTE MRE
Complication
• Obstruction • Fistulization or penetration • Intestinal hemorrhage • Perforation
Laboratory test
blood ：anemia ，ESR↑ tuberculin test：PPD/T-spot
2.Hypertrophic form • Commonly in cecum • granuloma , fiber hyperproliferation→ a rigid thickening of the பைடு நூலகம்owel wall→
Strictures → obstruction
Pathology
Pathology
according to the balance between the bacterium and patient immune
• Exudation • Caseation • Ulceration • Hypertrophy
Pathology
1.Ulcerative form
Diagnosis
1. Abdominal symptom of TB + toxemia of TB 2. X-ray 3. Endoscopy 4. extra bowel TB & PPD / T-spot
• Therapeutic trial of antituberculosis treatment for 2~6 weeks
Etiology & Pathogenesis
Why Ileocecal region is a common TB site : 1. a long stasis
2. abundant lymphatic tissue
Pathogenesis: Infection of TB ＋ strong toxicity ＋ large amount ＋ weakened immune condition ＋ reduced local resistibility
• Laparotomy
inflammation of bowel wall and regional lymph tissue
↓
caseous necrosis
↓ ulceration
↓ extensive fibrosis
↓ Strictures and fistulae
Pathology
1.Ulcerative form
irritable bowel condition
Clinic features
1. abdominal pain 2. Diarrhea and constipation 3. Palpable mass Hypertrophic type in the right iliac fossa
Clinic features
Endoscopy
Congestion, Edema Ulceration perpendicular to the long axis of the bowel inflammatory polyps stricture caseating granulomas
endoscopy
• Endoscopie Capsulaire • Enteroscopy
1.Ulcerative form
2.Hypertrophic form 3.Ulcerohypertrophic form
a subtype ， a combination of features of the ulcerative and hypertrophic forms.
Clinic features
1. abdominal pain right iliac fossa(髂窝） pain
referred pain of superior belly or peripheral umbilicus ； tenderness in that region
Clinic features
1. abdominal pain 2. Diarrhea and constipation • Diarrhea : ulcerative type • Constipation: hypertrophic type • Diarrhea alternated with constipation: