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Abdominal Tbpresentation Diagnosis and Treatment New
Abdominal Tbpresentation Diagnosis and Treatment New
TB:PRESENTATION,
DIAGNOSIS AND TREATMENT
Vishal Gajbhiye
ABDOMINAL TB CLASSIFICATION
Intestinal
- ulcerative
- hyperplastic
- perforative
Peritoneal
- wet
- dry/plastic
- fibrotic fixed
- acute primary peritonitis
Mesenteric involvement
- mass
- abscess
- nodal
Solid organ
- liver , spleen,pancreas
ETIOPATHOGENESIS
Primary
Secondary
Primary complex
Bacteremia
dormant
Secondary TB
INTESTINAL TUBERCULOSIS
Primary form – non-pasteurised dairy
products
10 rarely seen in India
Secondary form – swallowing infected
sputum, haematogenous from 10 focus
CLINICAL PRESENTATION
Intestinal obstruction
– Acute
– Subacute
– Chronic
Perforation
Ascites
– Diffuse
– Loculated
– Organized
Lump
– Abscess
– LN Mass
– Bowel mass
– IC mass
– Omental mass
SYSTEMIC MANIFESTATIONS
Weight loss
Fever
Night sweating
Nausea & Vomiting
Diarrhoea / Constipation
Anorexia
Amenorrhoea
Pulmonary
UNCOMMON PRESENTATION
Gastro-duodenal TB
Oesophagus
Segmental colonic
Rectal
Anal TB
Genitourinary TB
IMPORTANT CLINICAL FINDINGS
Doughy abdomen
Lump causes
IC mass
Omental mass
Cocoon
INVESTIGATIONS
Basic test
– TLC/DLC
– ESR
– Mantoux test
– Chest X-ray
– Plain X-ray abdomen
Diagnostictests
ELISA for TB
X-RAY ABDOMEN WITH
CALCIFIED LYMPH NODE
X-RAY ABDOMEN WITH
INTESTINAL OBSTRUCTION
USG IN ABDOMINAL TB
FINDINGS
Intra abdominal fluid
Septae
Peritoneal Thickening
Lymphadenopathy
GUIDED PROCEDURES
Ascitic tap
FNAC / Biopsy
USG SEPTATE ASCITES
USG NECROTIC/CALCIFIED
LYMPH NODE MASS
USG BOWEL/MESENTERIC
THICKENING
BARIUM CONTRAST STUDY
FINDINGES
Fleishner sign
Conical caecum
Increased IC angle
Multiple strictures
BARIUM CONTRAST STUDY
WITH IC-TUBERCULOSIS
BARIUM CONTRAST STUDY
WITH STRICTURES
CT SCAN ABDOMEN
Whenever diagnosis in doubt
FINDINGS
Lymphadenopathy – m/c
I C Mural thickening
High density ascities
Irregular soft tissue densities in omental area
CT SCAN TB LYMPHADENITIS
CT SCAN BOWEL THICKENING
CT-SCAN MESENTERIC AND
PERITONEAL THICKENING
ASCITES FLUID
Routinemicroscopy
AFB stain
AFB culture
TB PCR
ADA
– Serum > 42 IU/L
– Ascites fluid > 33 IU/L
SAAG < 1.1
LDH > 90 U/L
BACTEC FAST METHOD OF
TB CULTURE
IC TB
Indication of right hemicolectomy
Subacute obstruction
Coccon abdomen
SURGERY FOR
PERFORATION