內(nèi)科學教學課件：Intestinal tuberculosis Tuberculous peritonitis

Chapter6

Intestinaltuberculosis&TuberculousperitonitisSectionⅠ

Intestinaltuberculosis

Mycobacteriumtuberculosiscausedspecialinfectionofintestine

.

Etiology&Pathogenesis

Pathogenis

Mycobacteriumtuberculosis

Routesofinfection：

oral，swallowinfectedsputum,

mainroute

blood，miliarytuberculosis；

surroundingspread，peritoneal,pelviccavity

Etiology&PathogenesisWhy

IleocecalregionisacommonTBsite:

alongstasisabundantlymphatictissuePathogenesis:InfectionofTB＋strongtoxicity＋largeamount＋weakenedimmunecondition＋reducedlocalresistibility

Pathologyaccordingtothebalancebetweenthebacteriumandpatientimmune

ExudationCaseation

UlcerationHypertrophyPathologyUlcerativeforminflammationofbowelwallandregionallymphtissue↓

caseousnecrosis↓

ulceration↓

extensivefibrosis↓Stricturesandfistulae

Pathology1.Ulcerativeform2.HypertrophicformCommonlyincecumgranuloma

,fiberhyperproliferation→arigidthickeningofthebowelwall→Strictures

→obstructionPathology1.Ulcerativeform2.Hypertrophicform3.Ulcerohypertrophicformasubtype，acombinationoffeaturesoftheulcerativeandhypertrophicforms.

Clinicfeatures

1.

abdominalpainrightiliacfossa(髂窩）

painreferredpainofsuperiorbellyorperipheralumbilicus；tendernessinthatregionClinicfeatures

1.

abdominalpain2.DiarrheaandconstipationDiarrhea:ulcerativetypeConstipation:hypertrophictypeDiarrheaalternatedwithconstipation:irritablebowelconditionClinicfeatures

1.

abdominalpain2.Diarrheaandconstipation3.PalpablemassHypertrophictypeintherightiliacfossa

Clinicfeatures

1.

abdominalpain2.Diarrheaandconstipation3.Palpablemass4.

systemicandextrabowelsymptomsfevernightsweatsweightloss,AnemiaMalnutritionPulmonaryTBComplicationObstructionFistulizationorpenetrationIntestinalhemorrhagePerforationLaboratorytest

blood：anemia，ESR↑

tuberculintest：PPD/T-spotX-raytest

BariummealorenemaIrritablesign（Stierlinsign

），Ulceration,Nodularthickeningofmucosalfolds,

Shortannularstrictures

CTEnterography,CTEMREEndoscopy

Congestion,EdemaUlcerationperpendiculartothelongaxisofthebowel

inflammatorypolyps

stricturecaseatinggranulomas

endoscopyEndoscopieCapsulaireEnteroscopyDiagnosis

AbdominalsymptomofTB+toxemiaofTB

X-rayEndoscopyextrabowelTB&PPD/T-spotTherapeutictrialofantituberculosistreatmentfor2~6weeksLaparotomyDifferentiation1.Crohn’sdisease2.Coloncarcinoma3.ameba；schistosome；4.Others:non-Hodgkin

lymphoma；yersiniosis；syphilis;etal.TreatmentTarget:EliminatesymptomsImprovesystemicconditionHealthelesionControlcomplicationsTreatmentRestandnutrition2.AntituberculosischemicaltherapyAntisymptomatictreatmentspasmrelief，water-electrolytebalance,obstructionTreatmentOperationindication：completeobstruction，acuteperforationorrefractoryfistulaacutehemorrhagecan’tcontrolbymedicinediagnosticpurposePrognosisThekeyisearlyTheregularityoftreatmentPreventionBetimestreatthepulmonaryandotherTBNeverswallowthesputumDon’tusethesamedishwarewithothers------------controlthespreadingrouteSectionⅡ

TuberculousPeritonitisChronicanddiffusiveperitonealinfectionofMycobacteriumtuberculosis

Etiology&Pathogenesis

Pathogen：Mycobacteriumtuberculosis

Communicatedroute：

themainrouteislocalspreadfromcaseousmesentericnodesintestinaltuberculosistuberculoussalpingitis.輸卵管結(jié)核

HematogenousspreadPathology

1.

Exudativeform：Peritonealcongestion,edemamultiple,grayish-yellownodulestheexudatecoveringtheperitoneumappearedtobemorefibrinoidexcessiveasciticfluid(olivine黃綠）Pathology

1.

Exudativeform

2.

AdhesiveformheavyfibrotissueshypertrophyPeritoneum,mesenterywasthickenedAdhesionswerepresentIntestinalobstructionPathology

1.

Exudativeform2.Adhesiveform

3.CaseousformCaseousnecrosis，largenodulartuberclesrolledomentumaheavygelatinousexudateandloculationofanyfluidpresent.FisgulaSinustractClinicalmanifestation1.

generalsymptom：Toxemia:Fever,nightsweats,Malnutrition:latestageofsevereTBClinicalmanifestation1.

generalsymptom：2.Abdominalpain:dullpainininferiorabdomenActiveIntestinaltuberculosisMesentericnodulartuberculosisTuberculoussalpingitisIntestinalObstructionClinicalmanifestation1.

generalsymptom2.Abdominalpain3.AbdominalpalpationDoughy[`d?ui]abdomen---characteristicsignTendernessandreboundtenderness

Clinicalmanifestation1.

generalsymptom2.Abdominalpain3.Abdominalpalpation

4.AscitesmoveablesonantultrasonographyClinicalmanifestation1.

generalsymptom2.Abdominalpain3.Abdominalpalpation

4.Ascites5.Abdominalmass：rolledomentumEnlargedmesentericnodesAdhesiveintestineCaseousnecrosisClinicalmanifestation1.

generalsymptom2.Abdominalpain3.Abdominalpalpation

4.Ascites5.Abdominalmass6.Diarrhea,constipation,palpableliverComplicationIntestinalobstructionFistulaExaminations1.

Hb↓，

ESR↑↑

PPD/T-spot2.

ascites：kelly(grassgreen)colorexudativefliud.d>1.018，pro>25g/L，WBC>0.5×106,SAAG<11g/L,ADA↑.3.

ultrasonography：forminimascitesdetecting.4.X-ray：calcificationimplynodulartuberculosisbariummealforintestineadhesion,fistulaCTfordifferentiation5.LaparoscopeDiagnosis1.

Unclear

feverfor2weeks,withabdominalpainascites,doughyabdomen,mass

2.

ascitestest:exuda