《Tuberculosis Of Bone And Joint.ppt》由会员分享，可在线阅读，更多相关《Tuberculosis Of Bone And Joint.ppt（31页珍藏版）》请在三一办公上搜索。
1、Intestinal Tuberculosis,Second Affiliated hospitalYan Chen,Intestinal tuberculosis,General situationEtiology and pathogenesisPathologyClinical manifestation lab&other examinationDiagnosis and differential diagnosisTreatment,prognosis and prevention,General ideas,Developing countries(95%),especially
2、poverty,malnutrition,overcrowding and HIV coinfection.Involvement of intestine is usually secondary to pulmonary tuberculosis.,The ileocecal region is the most common area of involvement in the intestinal tract.Why?The abundance of lymphoid tissueLong residence time of bactera in ileocucum,Predispos
3、ing factors,Fatiguepoor sanitationmalnutritionlowered resistance etc.,Pathogenic organism-tubercle bacillus,tubercle bacillus maybe either the human type or bovine type human type-90%bovine type-10%,Etiology and pathogenesis,Route of transmissionPropagation by mouth:Hemotogenous dissemination:miliar
4、y TBSpread straightly:,Bacilium:number,virulenceDecreased immunity of humanWeakening of intestinal resistance,Etiology and pathogenesis,Caseation,Langhans giant cells,Clinical manifestation,Systemic symptoms Fatigue low-grade fever Night sweats Loss of weight poor appetite anemia,Local symptoms abdo
5、minal distension ascites mass abdominal pain diarrhea&constipation complication,Extraintestinal tuberculosis manifestation:pulmanory TB,Cachexia,laboratory findings,erythrocyte sedimentation rate,ESR ESR typically elevated in the active stage Stool routine test:occult blood,laboratory findings,PPD t
6、est purified protein derivative tuberculin skin test culture or histological examination of specimenbiopsy-microscopic tissue exam revealed tubercular histological feature of TB,Straight arrow show Conical and shrunken cecum;curved arrow show the narrowing of the terminal ileum,Radiography,In advanc
7、ed cases,symmetric annular stenosis and obstruction associated with shortening,retraction,and pouch formation may be seen.The cecum becomes conical,shrunken,and retracted out of the iliac fossa due to fibrosis within the mesocolon,Ileocecal valve becomes fixed,irregular,gaping,and incompeten,TB,Colo
8、noscopy,Colonoscopy,Ulceration,TB,TB,Imaging features,Ultrasonography,CT,MRIAsymmetric bowel wall thickeningAscitesInflammatory mass of bowel wallNarrowing of the terminal ileum with thickening and gaping of the iliocaecal valveFluid surrounding bowel caused by inflammation of the bowel wall,Other e
9、xaminations,Laparoscopic biopsy of tubercles found in the peritoneum or other partsLaparotomyCapsule endoscopyenteroscopy,Diagnosis&differential diagnosis,Younger patients presented with extraintestinal TBSymptom:toxic symptom diarrhea,abdominal pain,abdominal massX-ray:sterlin sign,stricture of bow
10、el,deformationColonoscopy and biopsy:inflammation,ulcer,polyp,striction caseating granuloma,bacterium(+)PPD test:strongly positiveExploratory laparotomy for patients difficult to be diagnosed Experimental treatment:2-8 weeks,Diagnostic criteria,Diagnosis&differential diagnosis,Differential diagnosis
11、Crohns disease:The major diagnostic dilemma of ITB is to differentiate it from CD.Right-sided colonic carcinomaAmoebiasis or schistosomic granulomaChronic bacillary Dysentery or choleraMalignant lymphomaFGID:IBS,functional diarrhea,TB&CD,TB CDExtraintestinal TB Course(relief and relapse)Fistula/absc
12、ess/peri-anal lesion Segmental appearance Form of ulcer transverse longitudinalCaseating granuloma by biopsy PPD test with strong positive Effective Anti-TB treatment,Femaleyears oldRight lower quadrant pain and fever,The ileocecal region,Sigmoid and Rectom,After treatment,Treatment,purpose:resolve symptom,improve constitutional condition,promote curing,prevent complication Measures:rest nutritional support anti-TB chemotherapy relieve symptom surgery,tuberculous peritonitis,Same as tuberculous pleurisy,Thanks to Dr Hang and Dr.Du for ppt.,Thank you!,
