Overview of liver tuberculosis
Hepatic tuberculosis is relatively rare, due to the lack of specific symptoms and signs, so the clinical misdiagnosis and misdiagnosis rate is high. Most hepatic tuberculosis is a part of systemic corniform tuberculosis, which is called secondary hepatic tuberculosis, and the patients mainly show the clinical manifestations caused by extrahepatic pulmonary and intestinal tuberculosis, and generally do not show the clinical symptoms of liver disease, and the intrahepatic tuberculosis can be cured after the anti-tuberculosis treatment, which makes it very difficult to make the diagnosis of hepatic tuberculosis in the clinic.
Questions you may be concerned about
What is the difference between hepatic tuberculosis and hepatic nodules?
Hepatic tuberculosis and hepatic nodules can be distinguished from each other in terms of disease definition and cause, pathology, disease manifestation and treatment means.
1. Disease definition and causes
(1) Hepatic tuberculosis: Hepatic tuberculosis is a disease, which is a series of pathological changes caused by Mycobacterium tuberculosis infection in the liver, and is less common than tuberculosis in other parts of the body.
(2) Hepatic nodule: Hepatic nodule is a symptom that can be secondary to a variety of diseases, such as cirrhosis, hepatocellular carcinoma, parasitic infection and other diseases.
2. Pathology
(1) Hepatic nodule: it mainly shows pathological changes such as localized tuberculous granulomatous inflammation.
(2) Hepatic nodule: depending on the primary pathology, it may manifest as foreign body granuloma, abnormally proliferated cancerous tissue, hepatic lobular sclerotic nodule and other manifestations.
3. Disease manifestations
(1) Hepatic nodule: it mainly manifests as low fever, night sweating, emaciation, etc. If it is combined with infections in other parts of the body, it will also manifest as coughing, urgency of urination, pain of urination, urgency of urination, and pain in joints.
(2) Liver nodule: its manifestations mainly depend on the primary disease, usually showing symptoms such as loss of appetite, nausea, vomiting and epigastric pain.
4. Therapeutic means
(1) Hepatic nodules: mainly treated with anti-tuberculosis drugs such as isoniazid and rifampicin, which should be used under the guidance of clinicians.
(2) Hepatic nodule: the treatment is mainly based on the primary pathology, such as using radiotherapy, chemotherapy, or surgery to treat hepatocellular carcinoma, and using surgery such as hepatic echinococcus endocystectomy to treat echinococcus and other parasitic infections.
When liver tuberculosis or liver nodules are suspected, it is necessary to actively consult a doctor for rational diagnosis and treatment under the guidance of a physician.
Causes
Mycobacterium tuberculosis belongs to the genus Mycobacterium in the order Actinobacteria, family Mycobacteriaceae, and is an acid-resistant bacterium with pathogenicity. They are mainly categorized into human, cow, bird and rat types. Those who are pathogenic to human are mainly human-type bacteria, and bovine-type bacteria are rarely infected. Hepatic tuberculosis is caused by various extrahepatic tuberculosis bacilli spreading to the liver, and sometimes the primary foci cannot be detected because the primary foci outside the liver are small or have already been cured, according to the statistics, those who can detect the primary foci only account for 35%.
Symptoms
The main symptoms of the disease include fever, loss of appetite, fatigue, pain in the liver area or right upper abdomen and hepatomegaly. Fever mostly occurs in the afternoon, sometimes accompanied by chills and night sweats; there are low fever and flaccid type, and the high fever can reach 39～41℃. 91.3% of the patients with fever symptoms have tuberculosis or have a clear history of tuberculosis, and those who have prolonged recurrent fever and exclude other causes often have the possibility of hepatic tuberculosis. Hepatomegaly is the main sign, more than half of them have tenderness, hard liver, nodular mass; about 15% of patients may have mild jaundice due to nodular compression of hepatic bile ducts, and 10% of cases have abdominal fluid.
Examination
1. Blood routine
The total number of leukocytes is normal or low, a few patients may have increased leukemia-like reaction; more than 80% of the patients have anemia, and the blood sedimentation rate is often accelerated.
2. Liver function tests
ALT, ALP and bilirubin are elevated, albumin may be reduced and globulin may be increased.
3. Tests related to tuberculosis infection.
4. Liver puncture biopsy
It is of greater diagnostic value for diffuse or millet-type lesions.
5. X-ray abdominal plain film
It may reveal intrahepatic calcified foci. It has been reported that 48.7% of patients with liver tuberculosis have intrahepatic calcified foci.
6. Ultrasound
Ultrasound can detect hepatomegaly and large intrahepatic foci, and can also be used to guide puncture examination of the foci.
7. CT scan
It can detect intrahepatic lesions.
8.Laparoscopy
It can find yellowish-white dotted or flaky lesions on the surface of the liver, and make puncture of lesions under direct vision for further examination of pathology and bacteriology.
9. Caesarean section
In individual difficult cases, a clear diagnosis can be obtained through surgical route if necessary.
Diagnosis
Diagnosis can be made on the basis of clinical manifestations combined with the above examinations.
Differential diagnosis
It needs to be differentiated from the following lesions:
1. Limited hepatic tuberculoma is sometimes difficult to be distinguished from hepatocellular carcinoma, while cornu-type hepatic tuberculosis is sometimes easily confused with diffuse hepatocellular carcinoma, but the latter can usually be distinguished from the latter with serious condition, rapid development of the disease, positive AFP, and combined with the history of chronic liver disease.
2. Liver tuberculosis forming abscess should be distinguished from amoebic or bacterial liver abscess. Bacterial liver abscess is mostly secondary to biliary tract infection, with severe systemic toxic symptoms, chills and high fever, while amoebic liver abscess has a history of pus and blood in the stools, and the abscess is usually large with chocolate-colored pus, which is not difficult to differentiate.
3. For cases with jaundice, it is prudent not to misdiagnose them as viral hepatitis, cirrhosis, leptospirosis, sepsis, etc. Especially when the patients have a history of tuberculosis or when the treatment is ineffective and deteriorates day by day, they should be alerted to the possibility of this disease and undergo the relevant examinations.
4. Liver and spleen enlargement, high fever, jaundice, anemia, malignant disease should be distinguished from lymphoma, acute leukemia, malignant reticulocytosis, and bone marrow image and lymph node biopsy can be checked.
Treatment
1. Anti-tuberculosis drug treatment
The drug regimen can refer to pulmonary tuberculosis, and the course of treatment should be extended appropriately. When patients with hepatic tuberculosis have abnormal liver function such as elevated ALT, it is not a contraindication to anti-tuberculosis treatment, but rather an indication, and ALT may fluctuate a little during the course of treatment, but it will return to normal soon.
2. Surgical treatment
For large tuberculous liver abscesses, surgical drainage or lobectomy can be considered along with effective anti-tuberculosis drug treatment.
Prognosis
Because the liver has rich reticuloendothelial tissue and strong reactivity, strong regeneration and defense ability, and can form a barrier effect in time, so liver tuberculosis has a tendency of self-healing. However, once the patient shows active hepatic tuberculosis manifestations such as high fever, chills, hepatomegaly, etc., it is difficult to recover by oneself; if special treatment is not given in time, it usually deteriorates rapidly and dies in several weeks or months. Anti-tuberculosis drug treatment can show immediate effect, and even in very serious cases, most of them can be cured.
The prognosis depends to a large extent on the correct clinical diagnosis, or how early the diagnosis is made. Deaths are most often due to misdiagnosis or too late diagnosis. Complications Severe liver failure due to fatty liver can be the cause of death. Jaundice indicates severe liver damage and has a poor prognosis.
Treatment with anti-tuberculosis drugs cures the milia type of liver tuberculosis in 6 to 8 months; for the other types, recovery may take longer.
Prevention
Prevention and treatment of primary extrahepatic tuberculosis is the key to preventing hepatic tuberculosis:
1. The first step should be to actively, as early as possible, and completely cure active tuberculosis and make sputum bacteria turn negative.
2. Adopt good hygiene habits and do not swallow sputum containing tubercle bacilli.
3. Apply the tableware of patients with active tuberculosis separately, and boil and sterilize them regularly to prevent cross-infection.
4. Milk must be pasteurized or boiled for drinking, do not drink raw milk.
5. Strengthen personal hygiene, sunbathe clothes, bedding and other daily necessities diligently to kill contaminated tuberculosis bacilli.
6. Strengthen physical exercise to improve the body’s ability to resist disease.