内科学课件：Tuberculous Abdomen
78页
1、,Tuberculous Abdomen,Colonscope,Barium Enema,Circumferential ulceration is characteristic of intestinal tuberculosis.,Epidemiology of GI TB,Extrapulmonary TB represented 28.2% of all reported TB cases. Gastrointestinal TB was the 2nd most common type of TB.,Extrapulmonary TB: difficult to diagnose?,Several forms of extrapulmonary TB lack any of the localizing symptoms or signs. Cutaneous anergy to PPD was noted in 35-50% of patients. No clinical or radiological evidence of pulmonary TB could be
2、found in up to one 3rd of these patients.,Introduction,TB can involve any part of GIT from mouth to anus, peritoneum 38(6):592-7.,Typical transverse ulcer,Histologically,Intestinal TB: granulomas are Large, multiple, confluent with caseation Ulcers lined by epitheliod histiocytes CD Fissuring ulcer, lymphoid aggregates, transmural inflammation, and Infrequent, small, noncaseating granulomas.,Am J Gastroenterol 2002;97:1446 1451. Pulimood et al. Gut 1999,Management,isoniazid rifampicin pyrazinami
3、de ethambutol Surgical intervention when needed,at least 6 months including 2 months of rifampicin, isoniazid, pyrazinamide，ethambutol However in practice t/t often given for 12 to 18 months obstructing lesions may relieve with Med alone However most will need surgery,before treatment,before treatment,after anti-tuberculosis treatment,1 year after treatment,before treatment 1999.11,1 and a half years after treatment,2 years and 3 months after treatment,Empirical anti-TB,If intestinal TB still possibility, give 4-6 weeks of anti-TB 30% of CD patietns at China receives anti-TB before final diagnosis,Presumptive diagnosis,can be established in A patient with active pulmonary tuberculosis and radiologic and clinical findings that suggest intestinal involvement. Response to anti-TB,Thank you,
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