Digestive system tuberculosis

Proven content

Tuberculosis of the digestive system usually occurs as a result of infection through the digestive tract, e.g. by ingestion of the patient’s own saliva, by using the patient’s cutlery and dishes, or by the consumption of milk or milk products infected with mycobacteria of the bovine type. It can also be the result of mycobacterial shedding. Most often it is located in the large intestine or the end part of the small intestine in the form of a lumpy inflammatory infiltrate or ulcerative enteritis.

Digestive system tuberculosis

Digestive tuberculosis can affect any part of the digestive tract. It usually occurs as a result of an oral infection, for example by using the same cutlery and kitchenware as the sick person or by eating milk products infected with bovine tuberculosis. Most often, tuberculosis affects the peritoneum, followed by the intestines. Less commonly, it develops in the duodenum, tongue, esophagus or stomach.

In the course of tuberculosis of the digestive system there are persistent symptoms in the form of long-lasting diarrhea that destroys the body, accompanied by severe, chronic, usually variable abdominal pain (flatulence), low-grade fever, general weakness and anemia. The longer-lasting process of tuberculosis also causes changes in the local lymph nodes, sometimes leading to their nodular enlargement and secondary sero-necrotic changes. Infiltrative-nodular changes can cause intestinal obstruction symptoms and trigger tuberculous peritonitis.

Digestive system tuberculosis – types

1. SPLENDULUM

It is a very rare condition that usually arises from blood spreading. The lesions may be focal or disseminated, and tuberculosis itself may be acute, subacute or chronic.

2. Pancreatic tuberculosis

Pancreatic tuberculosis usually occurs as a result of disseminated tuberculosis or is associated with tuberculosis of other abdominal organs. The disease affects both men and women, and the average age of onset is 40 years.

The general symptoms of pancreatic tuberculosis are:

1. stomach pain,
2. general weakness
3. low-grade fever,
4. weight loss
5. nausea,
6. vomiting.

The symptoms are related to the nature of the lesions in the area of ​​the pancreas. In order to diagnose pancreatic tuberculosis, it is necessary to perform a histopathological examination in which infiltrative, ulcerative and disseminated lesions are visible. If the diagnosis has not been made despite the needle biopsy, laparoscopy should be performed. It happens that the final diagnosis is made only on the basis of the examination of the resected pancreas.

3. TUBEROUS OF THE LANGUAGE

It is a condition that is rarely diagnosed. It arises as a result of contact with contaminated food or sputum, and as a result of spreading blood and lymph. The infection develops in people who do not pay attention to personal hygiene of the oral cavity, have mechanical damage to it or chronic mucosal catarrh. In addition, smoking and excessive alcohol consumption are a factor that increases the risk of the disease.

The lesions are usually small and located at the base of the tongue. They have the form of small (single or multiple) ulcers, vesicles, lumps and flat infiltrates. Patients experience pain while eating and speaking (due to tongue movements). Sometimes enlarged lymph nodes can be observed in patients. Tongue tuberculosis usually accompanies other tuberculosis, such as pulmonary tuberculosis.

For diagnosis, an anatomical examination of the specimens is necessary.

4. LIVER TUBERS

Liver tuberculosis may be a complication of chronic pulmonary tuberculosis, or may occur in the course of miliary tuberculosis or as an isolated form. In addition, people infected with HIV may develop tuberculous liver abscesses.

Patients with tuberculosis of the disease develop symptoms in the form of:

1. lack of appetite
2. night sweating
3. high body temperature,
4. weight loss
5. abdominal pain (usually diffuse, located in the right subcostal area),
6. enlarged liver (found in half of the patients)
7. enlarged spleen,
8. jaundice (rare)
9. ascites (rarely),
10. portal hypertension (especially in nodular form).

In the diagnosis of the disease, histological changes are revealed, which are small, diffuse, not larger than 2 mm granulomas, single nodular changes or multiple tuberculomas (they can disintegrate, causing abscesses). In addition, a sample for bacteriological examination is taken.

The imaging tests include:

1. abdominal x-ray (which may reveal liver calcifications),
2. ultrasound examination (helpful in the diagnosis of an enlarged liver or the presence of focal lesions),
3. computed tomography (helps to accurately visualize lesions),
4. fine-needle biopsy under ultrasound guidance or during laparoscopy.

It is important to differentiate liver tuberculosis with other diseases, e.g. bacterial liver abscess, primary cancer (or metastases), and an abscess in the course of malaria, which is very rare in Poland. In the differentiation of tuberculous and bacterial liver abscess, it is necessary to perform additional tests in the form of peripheral blood counts and bacteriological examination of the collected material.

5. STOMACH AND INTESTINES

It usually occurs due to the ingestion of sputum in which tuberculosis is present. Infection can also occur through blood dissemination during primary infection. In women, on the other hand, the infection spreads through the continuity of changes in the genital tract. In some countries (e.g. where pasteurized milk is rarely consumed), drinking of milk and its products contaminated with mycobacteria may be a source of contamination. In people with reduced acidity of gastric juice and after gastric resection – there is a greater risk of developing gastric and intestinal tuberculosis.

The disease can affect virtually any part of the digestive tract from the mouth to the anus, but it usually affects the small intestine. Another equally common location of the disease is the large intestine, less often the anus and rectum. The onset of gastrointestinal tuberculosis can be acute, chronic or insidious onset, and is completely asymptomatic in some patients. Thus, the changes may persist for a long time before the patient consults a doctor. The general symptoms of this disease are:

1. weight loss
2. low-grade fever,
3. anemia,
4. colic-like abdominal pain in the area of ​​the lower abdomen and navel,
5. nausea,
6. abdominal distension
7. vomiting,
8. chronic diarrhea.

A complication of gastrointestinal tuberculosis may be slowly developing obstruction (which is sometimes the first symptom of tuberculosis).

In the course of diagnostics of intestinal tuberculosis, many diagnostic methods are used: bacteriological tests; endoscopic examinations and radiological examinations. Yet another examination is the anatomical examination of the intestines, which detects three types of lesions: ulcerative, ulcerative-hypertrophic and hypertrophic.

Gastrointestinal tuberculosis should be differentiated from the following diseases:

1. actinomycetes,
2. lymphoma,
3. cancer of the cecum,
4. appendicitis abscess,
5. abscess of the fallopian tubes and ovaries,
6. malaria,
7. Crohn’s disease (causes the greatest diagnostic problems because the location of lesions and the radiological and histopathological lunch are similar to tuberculosis).

Treatment of ailments is similar to that used in pulmonary tuberculosis. Sometimes it is necessary to perform surgery, especially in patients with intestinal perforation, intestinal obstruction, and the presence of abscesses and fistulas.

6. PETROLEUM

Peritoneal tuberculosis can occur due to transmission of infection from the intestines, fallopian tubes, or mesenteric nodes. It may also be caused by the spread of blood-borne infection from the primary focus in the lung. Peritoneal tuberculosis may coexist with tuberculosis of other organs, e.g. tuberculosis of the abdominal cavity. In turn, in HIV-infected individuals, peritoneal involvement is always a symptom of generalized tuberculosis. Peritoneal tuberculosis can occur in patients of all ages, but most often these are people between 30-40 years of age who abuse alcohol.

The symptoms of peritoneal tuberculosis are usually hidden and take several weeks / months to develop. Typically, patients develop:

1. weight loss
2. lack of appetite
3. fever,
4. general weakness.

With the development of the disease, abdominal pain and significant enlargement of its circumference may appear. Most people experience abdominal pain when they touch it. There may also be symptoms of an obstruction caused by the attachment of mesentery nodes to the intestines. A certain group of patients also develop nausea, vomiting and diarrhea.

In addition, people with coexisting pulmonary tuberculosis may develop cough and hemoptysis.

An ultrasound examination and a computer examination of the abdominal cavity are used to diagnose the disease. The ultrasound examination shows enlarged retroperitoneal nodes and the nodes of the line. In addition, it is possible to find out where the fluid is and to designate a puncture site. Ultrasound is also performed to control the progress of treatment. In turn, computed tomography is more sensitive and allows for a more accurate imaging of lesions. Peritoneal fluid culture or peritoneal biopsy are helpful in establishing a XNUMX% diagnosis. However, the most effective diagnostic method is still laparoscopy, thanks to which it is possible to analyze the lesions and collect specimens for bacteriological and anatomopathological examinations. Laparoscopy shows a thickened peritoneum with adhesions and yellowish-white nodules.

The treatment uses anti-tuberculosis therapy, which reduces the death rate. Too late diagnosis and implementation of appropriate treatment significantly worsens the prognosis of the disease. As is the coexistence of liver diseases and patients over 60 years of age.

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