Intestinal tuberculosis is a relatively common form of extrapulmonary tuberculosis, a chronic infection caused by invasion of the intestinal tract by Mycobacterium tuberculosis. The vast majority of cases are secondary to extraintestinal tuberculosis, especially open pulmonary tuberculosis. The age of onset is mostly young adults, with slightly more women than men. Intestinal tuberculosis is generally caused by human tuberculosis bacilli, and occasionally bovine tuberculosis may develop from drinking bacteriophage milk or dairy products.
1, gastrointestinal infection is the main mode of infection of intestinal tuberculosis.
2. Blood-borne transmission Blood-borne transmission is also one of the ways of infection of intestinal tuberculosis. It is seen in the hematogenous spread of the tuberculosis pathway and invade the intestine.
3, adjacent tuberculosis foci spread intestinal tuberculosis can also be caused by the direct spread of intra-abdominal tuberculosis foci, such as tuberculosis of the fallopian tube, tuberculous peritonitis, mesenteric lymphatic tuberculosis, etc.. This infection is spread through the lymphatic vessels.
Symptoms
Most of them have a slow onset and a long course, and the typical clinical manifestations are summarized as follows.
1, abdominal pain because the lesion often involves the ileocecal region, so the pain is most commonly found in the right lower abdomen, and limited pressure points can be found on palpation. The pain can also be located around the umbilicus, and is generally mild, vague or dull, or intermittent, often triggered during or after meals. When proliferative intestinal tuberculosis is complicated by intestinal obstruction, the abdominal pain is mainly colic, and there are corresponding symptoms of intestinal obstruction.
2, diarrhea and constipation alternately diarrhea is one of the main symptoms of ulcerative intestinal tuberculosis, which is caused by inflammation and ulcer stimulation of intestinal curvature, accelerated intestinal peristalsis, rapid evacuation and secondary malabsorption. The bowel movements are usually 2-4 times a day, mostly pasty stools, containing only a small amount of mucus in mild cases, but in severe cases the diarrhea can be up to 10 times a day, with mucus and pus in the stool, and blood in the stool is rare. In addition, there can be intermittent constipation, feces in the form of sheep feces, or diarrhea and constipation alternately.
3. Abdominal masses are mainly seen in hyperplastic intestinal tuberculosis, where the intestinal wall is thickened locally to form a mass. When ulcerative intestinal tuberculosis and surrounding tissues are adherent, or when mesenteric lymphatic tuberculosis is also present, a mass can be formed and can be felt. The mass is usually located in the right lower abdomen, moderately hard, and may have light pressure pain.
4, systemic symptoms of ulcerative intestinal tuberculosis often have tuberculosis toxemia, such as afternoon hypothermia, irregular fever, flaccid fever or retention fever, accompanied by night sweats, may have weakness, wasting, anemia dystrophic edema and other signs and symptoms, and can have extra-intestinal tuberculosis, especially tuberculous peritonitis, pulmonary tuberculosis and other related manifestations, proliferative intestinal tuberculosis without tuberculosis symptoms, longer duration of disease, better general condition.
Examination
1, blood picture and sedimentation white blood cell count is generally normal, red blood cells and hemoglobin are often low, showing mild to moderate anemia, with ulcerated patients being the most common. In patients with active lesions, blood sedimentation is often increased.
2.Fecal examination stool concentration to find tuberculosis bacteria, only when sputum bacteria negative, it is meaningful.
3.X-ray examination barium meal X-ray imaging or barium enema examination is important for the diagnosis of intestinal tuberculosis.
4.Fiber colonoscopy can directly observe the lesions in the whole colon, cecum and ileocecal region, and biopsy or sampling for bacterial culture is feasible.
Treatment
1, rest and nutrition reasonable rest and nutrition should be the basis of treatment of tuberculosis. Active intestinal tuberculosis should emphasize bed rest, reduce caloric consumption, improve nutrition and increase the body’s ability to resist disease.
2, the drug treatment of intestinal tuberculosis, like pulmonary tuberculosis, should emphasize early, combined, appropriate, regular and whole drug use.
3, symptomatic management and surgical treatment of abdominal pain can be used belladonna, atropine or other anticholinergic drugs. Incomplete intestinal obstruction sometimes requires gastrointestinal decompression, and correction of water and electrolyte disorders. If there are signs of anemia and vitamin deficiency, symptomatic medication is used.
Surgical treatment is mainly limited to those with complete intestinal obstruction or partial intestinal obstruction that does not improve with medical treatment, those with acute intestinal perforation causing fecal fistula that does not improve with conservative treatment, and those with massive intestinal bleeding that fails to stop bleeding with active resuscitation.
Intestinal tuberculosis is often secondary to pulmonary tuberculosis, so the diagnosis of the original disease should be made, active treatment, strengthening public health publicity, educating patients to avoid swallowing sputum and not spitting, and milk should be adequately sterilized.