tuberculousperitonitis结核性腹膜炎课件
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Abdominal Tuberculosis 腹部结核病
Zhou Liu Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen center
General consideration
? Can affect any organ in the abdomen ? Importance of clinical context in diagnosis
mimic Crohn's disease
Fixed and narrowed ileum（回肠 固定及变窄） ;
Conical and shrunken cecum（锥 形和萎缩的盲肠）
Uniform and concentric thickening of terminal ileum wall （回肠末端肠壁向心性均匀增厚）
Granuloma formation 肉芽肿形成
Lymph nodes 淋巴结
Caseous necrosis 干酪性坏死
Spreading
Peritoneum 腹膜
Cicatrization 瘢痕形成
Circulation liver肝
pancreas胰 spleen脾
6
4
5
3
2
1 ileocecal junction(
Progressing
ileocecal tuberculosis 回盲部结核
Mild wall thickening of the cecum（盲肠壁轻 度增厚）
Pericecal lymph nodes（盲肠周围淋巴结）
ileocecal tuberculosis 回盲部结核 Circumferential thickening of the cecum and
Pathophysiology of Gastrointestinal TB
（胃肠道TB的病理生理学）
Bacteria
Mucosa 粘膜
Submucosa 粘膜下层
Surrounding mucosa thickening
邻近粘膜增厚
Sloughing 脱落
Ulceration 溃疡
Epithelioid tubercles 表皮样结节
terminal ileum（盲肠和末端回肠壁环形增厚） Adjacent lymph nodes（邻近淋巴结）
Differentiating imaging features
Tuberculosis Asymmetric, irregular wall thickening Fleischner sign on barium studies No creeping fat
Positive chest film (50%) Omental and peritoneal thickening Enlarged lymph nodes with low-denstity centers
ห้องสมุดไป่ตู้
Crohn's disease Circumferential bowel wall thickening Cobblestone appearance on barium Creeping fat (abnormal quantity of mesenteric fat Negative chest film Normal omentum and peritoneum Enlarged soft-tissue density lymph nodes
90%)
? Complications of intestinal tuberculosis ?Bowel obstruction（肠梗阻） ?Perforation（穿孔） ?Abscess formation（脓肿形成） ?Fistula（瘘道形成） ?Intussusception（肠套叠） ?Bowel wall ischemia（肠壁缺血）
Different pathways
Modes of involvement in abdominal tuberculosis By ingestion（吞咽）
Infected food or milk- Primary intestinal tuberculosis（原发性肠结核） Infected sputum（痰）-Secondary intestinal tuberculosis（继发性肠结核） Hematogenous spread from distant tubercular focus（血性播散） Contagious spread from infected adjacent foci（邻近累及） Through lymphatic channel（淋巴扩散）
Classification
? Gastrointestinal tuberculosis （胃肠道结核） ? Tuberculous lymphadenopathy （结核性淋巴结炎） ? Tuberculous peritonitis （结核性腹膜炎） ? Solid organ involvement （实性器官累及） ?Hepatic and splenic TB ?Pancreatic TB
?High-risk population ：immunocompromised patients, especially AIDS （免疫抑制的病人） ?Typical symptoms: such as diarrhea, fever etc （腹泻、发热等） ?Laboratory findings （实验室检查）： serum and culture （血清和培养） ?Histologic analysis （组织学检查） ? Radiological findings might mimic many different disease ?Inflammatory disease ：Crohn's disease ?Neoplastic disease: Lymphomatosis, Peritoneal carcinomatosis
Zhou Liu Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen center
General consideration
? Can affect any organ in the abdomen ? Importance of clinical context in diagnosis
mimic Crohn's disease
Fixed and narrowed ileum（回肠 固定及变窄） ;
Conical and shrunken cecum（锥 形和萎缩的盲肠）
Uniform and concentric thickening of terminal ileum wall （回肠末端肠壁向心性均匀增厚）
Granuloma formation 肉芽肿形成
Lymph nodes 淋巴结
Caseous necrosis 干酪性坏死
Spreading
Peritoneum 腹膜
Cicatrization 瘢痕形成
Circulation liver肝
pancreas胰 spleen脾
6
4
5
3
2
1 ileocecal junction(
Progressing
ileocecal tuberculosis 回盲部结核
Mild wall thickening of the cecum（盲肠壁轻 度增厚）
Pericecal lymph nodes（盲肠周围淋巴结）
ileocecal tuberculosis 回盲部结核 Circumferential thickening of the cecum and
Pathophysiology of Gastrointestinal TB
（胃肠道TB的病理生理学）
Bacteria
Mucosa 粘膜
Submucosa 粘膜下层
Surrounding mucosa thickening
邻近粘膜增厚
Sloughing 脱落
Ulceration 溃疡
Epithelioid tubercles 表皮样结节
terminal ileum（盲肠和末端回肠壁环形增厚） Adjacent lymph nodes（邻近淋巴结）
Differentiating imaging features
Tuberculosis Asymmetric, irregular wall thickening Fleischner sign on barium studies No creeping fat
Positive chest film (50%) Omental and peritoneal thickening Enlarged lymph nodes with low-denstity centers
ห้องสมุดไป่ตู้
Crohn's disease Circumferential bowel wall thickening Cobblestone appearance on barium Creeping fat (abnormal quantity of mesenteric fat Negative chest film Normal omentum and peritoneum Enlarged soft-tissue density lymph nodes
90%)
? Complications of intestinal tuberculosis ?Bowel obstruction（肠梗阻） ?Perforation（穿孔） ?Abscess formation（脓肿形成） ?Fistula（瘘道形成） ?Intussusception（肠套叠） ?Bowel wall ischemia（肠壁缺血）
Different pathways
Modes of involvement in abdominal tuberculosis By ingestion（吞咽）
Infected food or milk- Primary intestinal tuberculosis（原发性肠结核） Infected sputum（痰）-Secondary intestinal tuberculosis（继发性肠结核） Hematogenous spread from distant tubercular focus（血性播散） Contagious spread from infected adjacent foci（邻近累及） Through lymphatic channel（淋巴扩散）
Classification
? Gastrointestinal tuberculosis （胃肠道结核） ? Tuberculous lymphadenopathy （结核性淋巴结炎） ? Tuberculous peritonitis （结核性腹膜炎） ? Solid organ involvement （实性器官累及） ?Hepatic and splenic TB ?Pancreatic TB
?High-risk population ：immunocompromised patients, especially AIDS （免疫抑制的病人） ?Typical symptoms: such as diarrhea, fever etc （腹泻、发热等） ?Laboratory findings （实验室检查）： serum and culture （血清和培养） ?Histologic analysis （组织学检查） ? Radiological findings might mimic many different disease ?Inflammatory disease ：Crohn's disease ?Neoplastic disease: Lymphomatosis, Peritoneal carcinomatosis