医学培训课件 结核性腹膜炎英文版.ppt

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1、,Tuberculous Abdomen,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 extrapu

2、lmonary 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 found in up to one 3rd of these patients.,Introduction,TB can involve any part of GIT from mouth to anus, peritoneum 38(6):5

3、92-7.,Endoscopic diagnosis?,Lee et al hypothesized that a diagnosis of Crohns disease could be made when the number of parameters characteristic of Crohns disease was higher than the number of parameters characteristic of intestinal tuberculosis, and vice versa.,Endoscopy. 2006 Jun;38(6):592-7.,Endo

4、scopic findings: TB,In tuberculosis patients, transverse ulcers with surrounding hypertrophic mucosa and multiple erosions were usual colonoscopic findings.,Am J Gastroenterol 1998;93: 606609. Gastrointest Endosc 2004;59:362-8.,Typical transverse ulcer,Gastrointest Endosc 2004;59:362-8.,Radiology,th

5、ickened bowel wall with distortion of the mucosal folds and ulcerations. CT may show preferential thickening of the ileocecal valve and medial wall of the cecum and massive lymphadenopathy with central necrosis. Calcified mesenteric lymph nodes and an abnormal chest film are other findings that aid

6、in the diagnosis of intestinal tuberculosis.,At surgery: TB,Reduced largely since introduction of colonoscopy Indications: Mass lesions associated with the hypertrophic form, because they can lead to luminal compromise with complete obstruction. Surgery also may be necessary when free perforation, c

7、onfined perforation with abscess formation, or massive hemorrhage occur. Findings: The bowel wall appears thickened with an inflammatory mass surrounding the ileocecal region. The serosal surface is covered with multiple tubercles. The mesenteric lymph nodes frequently are enlarged and thickened.,Hi

8、stologically,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

9、,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!,