extraintestinal tuberculosis
Introduction
Introduction Intra-abdominal tuberculosis is a clinically common extrapulmonary tuberculosis, a chronic infection caused by tuberculosis invading the intestine. The vast majority are secondary to extraintestinal tuberculosis, especially open tuberculosis. The age of onset is mostly young and middle-aged, and women are slightly more than men.
Cause
Cause
Intestinal tuberculosis is generally caused by human tuberculosis, occasionally due to drinking bovine milk or dairy products suffering from bovine tuberculosis, the main ways in which tuberculosis invades the intestines are:
First, gastrointestinal infection
For the main infection mode of intestinal tuberculosis, patients with open tuberculosis, secondary infection due to frequent swallowing of their own sputum containing tuberculosis; or frequent close contact with tuberculosis patients. Also neglecting disinfection and isolation measures can cause primary intestinal tuberculosis.
After tuberculosis is ingested, most of it is not killed by gastric acid because it has a lipid-containing outer membrane. When the pathogen reaches the intestine (especially in the ileocecal area), the food containing Mycobacterium tuberculosis has become a sputum, there is a greater chance of direct contact with the intestinal mucosa, and there are physiological retention and reverse motility due to ileocecal area.
Second, the blood line spread
Hematogenous dissemination is also one of the routes of infection of intestinal tuberculosis. Seen in the miliary tuberculosis, the blood line spread and invaded the intestines.
Third, the spread of adjacent TB lesions
Intestinal tuberculosis can also be caused by direct spread of intra-abdominal tuberculosis lesions, such as tubal tuberculosis, tuberculous peritonitis, mesenteric lymphatic tuberculosis. This infection is spread through the lymphatics.
Tuberculosis, like many other diseases, is the result of interactions between the human body and bacteria (or other pathogenic factors). Only when the number of invading Mycobacterium tuberculosis is large, the virulence is strong, and the immune function of the organism is abnormal (including the local resistance weakened by intestinal dysfunction) can cause disease.
Examine
an examination
History and symptoms:
Pain in the right lower abdomen or umbilical cord and dull pain, mostly induced after eating, with incomplete intestinal obstruction, abdominal pain is persistent, paroxysmal aggravation. Fecal habits change, diarrhea, feces are mushy, can contain mucus, not accompanied by urgency and heavy, blood in the stool is rare. Or diarrhea and constipation alternate. Proliferative intestinal tuberculosis, more than secret. More often accompanied by fever, night sweats, weight loss, general malaise, nausea, vomiting, bloating, loss of appetite and other symptoms. In addition, you should pay attention to whether there is a history of tuberculosis and previous examination and treatment, whether it is anti-spasmodic treatment, treatment course and curative effect.
Experience discovery:
There is a fixed tenderness point in the right lower abdomen. In the case of intestinal obstruction, there may be bowel sounds, intestinal type and peristaltic wave. Proliferative intestinal tuberculosis can touch the mass in the right lower abdomen. It is generally fixed, medium-hard, with light weight. tenderness. In addition, there are signs of anemia, detailed examination of the physical signs of the patient to help determine the severity of the disease and the pathological classification of intestinal tuberculosis.
The diagnosis of a typical case is generally not difficult. However, in the early stage of the disease, it is often missed because of the obvious symptoms or lack of characteristics.
The following points can be used as a basis for diagnosing this disease.
1. Young and middle-aged patients, the original parenteral tuberculosis, especially open tuberculosis, or a close contact with patients with open tuberculosis;
2, diarrhea, abdominal pain, constipation and other gastrointestinal symptoms, accompanied by fever, night sweats and other systemic symptoms;
3, abdominal examination found that the lower right abdomen tenderness, or with a mass, or unexplained intestinal obstruction;
4, blood test: may have moderate anemia, white blood cell count is normal, lymphocytes increase, blood sedimentation is significantly increased;
5, stool examination: feces are mostly paste-like, generally do not contain mucus or pus, a small number of pus cells and red blood cells can be seen by routine microscopy. The feces are concentrated to find Mycobacterium tuberculosis, and the positive ones are helpful for the diagnosis of intestinal tuberculosis, but only when the sputum test is negative;
6, X-ray examination: tincture in the lesions of the intestines showed signs of irritability, emptying quickly, poor filling, and the filling of the upper and lower intestines of the lesions is good, the ileum retention in the end of the ileum. If the diseased intestine can be filled, the mucosal folds are rough and the edges of the intestinal wall are irregular and sometimes jagged. It can also be seen that the intestinal lumen is narrowed, the intestinal segment is contracted and deformed, and the normal angle of the ileum cecum disappears;
7, fiber colonoscopy: generally do not routinely check. If the lesion involves the upper colon, in order to determine the nature and extent of the ulcer, it is very helpful for diagnosis and differential diagnosis.
In addition, in the early stage of the disease, because the symptoms are not obvious, the diagnosis is often difficult, and sometimes the X-ray examination is also negative, so patients suspected of intestinal tuberculosis should be followed up regularly or for diagnostic anti-tuberculosis treatment.
Diagnosis
Differential diagnosis
First, Crohn's disease
The clinical manifestations and X-ray signs of this disease are very similar to intestinal tuberculosis. Sometimes it is difficult to identify. The following points can be used to assist in the diagnosis: 1 The disease has no history of tuberculosis or extraintestinal tuberculosis; 2 The course of disease is generally longer, without anti-tuberculosis treatment. Intermittent remission can occur; 3 fecal and other body fluids and secretions are checked for no tuberculosis; 4X-ray examination shows lesions mainly at the end of the ileum, multiple segments of intestinal tract involvement, and a segmental distribution; 5 intestinal obstruction, fecal fistula, etc. The disease is more common than intestinal tuberculosis; 6 resection of the diseased intestine for pathological examination without cheese-like necrosis, microscopic examination and animal inoculation without tuberculosis.
Second, right colon cancer
1 The age of onset of this disease is mostly middle-aged and older people over 40 years old;
2 no long-term low fever, night sweats and other tuberculosis toxemia and tuberculosis history;
3 The condition is progressively aggravated, and the systemic symptoms such as weight loss, paleness, and weakness are obvious;
4 The abdominal mass began to appear slightly more mobile and no tenderness, but the surface of the intestinal tuberculosis was hard and the nodule was obvious;
The 5X line examination mainly has the filling defect of the expectorant, the lesion is limited, and the ileum is not involved;
6 intestinal obstruction occurred earlier and more frequently;
7 fiber colonoscopy can be seen in the tumor, biopsy can often be diagnosed. The incidence of colon cancer is higher than that of intestinal tuberculosis in clinical practice.
Third, amoeba or schistosomiasis granuloma
Intestinal amoeba or schistosomiasis can form granulomatous lesions, which should be noted in differential diagnosis. This type of disease has no history of tuberculosis, pus and blood is more common, and the relevant pathogens are found in the stool. Rectal and colonoscopy can often confirm the diagnosis, and the corresponding specific treatment is effective.
Fourth, other diseases
In addition to the above diseases, intestinal tuberculosis should be differentiated from the following diseases: abdominal pain, diarrhea as the main manifestation should be differentiated from abdominal lymphoma, enterobacterial disease; acute lower right abdominal pain as the main performance should pay attention to avoid Misdiagnosed as acute appendicitis; those with chronic abdominal pain involving the upper abdomen are easily confused with peptic ulcers and chronic cholecystitis; those with high fever should be excluded from typhoid fever.
