Abdominal tuberculosis

Abdominal tuberculosis does not have pathognomonic symptoms. Many recognize are often met with various common diseases. Therefore, the bulk of patients with abdominal tuberculosis is examined in the general treatment network under all sorts of diagnoses. Most cases of complicated course of abdominal tuberculosis are the reason for urgent operations in general hospitals, which are subject to up to 25% of patients.

In recent years, there has been an increase in the number of patients hospitalized with generalized and neglected forms of abdominal tuberculosis, as well as with complications that develop after inadequate surgical interventions in the general treatment network. Until now, the periods from the primary treatment of a patient with abdominal tuberculosis to the medical network remain unjustifiably high until a correct diagnosis has been made.

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Tuberculous peritonitis

Tuberculous peritonitis (tuberculosis of the peritoneum) is attributed mainly to manifestations of the period of primary tuberculosis infection as a result of lympho-hematogenous spread of the process, or it is a complication in the specific lesion of the lymph nodes of the abdominal cavity, intestines, genital organs, spine, spreading by contact and lymphogenous way.

Regardless of the genesis, the picture of the disease in peritonitis may occupy a dominant position in the general symptomatology of the disease or be associated with the major disease severity (for tuberculous mesagenitis and intestinal lesions, etc.). Particularly severe peritonitis develops after perforation of the tuberculous ulcer of the intestine into the abdominal cavity or break of the caseous lymph nodes of the mesentery. In the period of secondary tuberculosis, the spread of the process from the mesenteric nodes, intestines and genital organs leads more often to the development of dry forms of peritonitis with the defeat of limited areas of the peritoneum.

There are tubercular, exudative, exudative-adhesive and casein-ulcer forms of tuberculous peritonitis. Tubercular tubercular peritonitis is characterized by acute course, begins with an increase in body temperature, the appearance of chills and abdominal pain. The tongue is dry, with a whitish bloom. The anterior abdominal wall is tense, does not participate in breathing: the symptoms of irritation of the peritoneum (symptoms of Voskresensky, Shchetkin-Blumber, Sitkovsky, etc.) are clearly revealed. The absolute majority of patients operate on an emergency basis with the diagnosis of "acute abdomen", etc. In this case, tuberous eruptions are found along the peritoneum.

Exudative tubercular peritonitis is the outcome of a tubercular or allergic reaction to toxins of mycobacterium tuberculosis. It is characterized by the formation of exudate in the abdominal cavity. The disease develops gradually from the appearance of undefined abdominal pain, unstable stool, subfebrile body temperature, weakness, dyspeptic disorders. The abdomen increases in volume, sometimes significantly. Symptoms of irritation of the peritoneum are smoothed, the presence of ascites fluid is determined.

Adhesive form of peritonitis is the result of a complicated course of tuberculosis of the abdominal cavity with the formation of multiple adhesions. The clinical course is undulating. Patients complain of general weakness, abdominal pain, nausea, diarrhea. Adhesion of the intestinal obstruction is a frequent complication. Exudative-adhesive peritonitis is characterized by the appearance of a drained exudate, which is determined by percussion. The general condition of the patient remains satisfactory for a long time. The caseous-ulcerative form of peritonitis is distinguished by the appearance of foci of curdled necrosis on the parietal and visceral peritoneum with the formation of ulcers of various sizes. The clinical course of the disease resembles a pattern of adhesive peritonitis. This is the most severe form of tuberculous peritonitis. Often observed complications in the form of fistula in the internal organs and out through the abdominal wall. The general condition of the patients is extremely severe, they note a high body temperature.

Tuberculous mezadenitis

The clinical course of tubercular mezadenitis is distinguished by the absence of pathognomonic symptoms. It can be acute and chronic, with remissions and exacerbations. In acute course, abdominal pains of different localization are noted, but more often in the navel, left hypochondrium and right iliac region. Pain can be intense and resemble a picture of an acute abdomen. Usually the stomach is evenly swollen, not tense, the anterior abdominal wall participates in breathing. When palpating the abdomen, a moderate pain to the left of the navel is revealed (positive symptom of Sternberg), a positive symptom of Klyn (displacement of soreness when moving the patient to the left side). Symptoms of irritation of the peritoneum are not pronounced. The enlarged caseous lymph nodes that would have been accessible by palpation, especially in adults, are observed as an exception.

Chronic tubercular mesadenitis proceeds wavy, periods of exacerbations are replaced by remissions. The most common symptom is pain in the abdomen, which corresponds to the localization of the pathological process (from the projection of the mesentery root). By the nature of pain can be blunt whining or in the form of colic. Patients often complain of bloating, increasing by the end of the day. The pain is often due to the pressure of the calcified lymph nodes on the neurovascular bundle of the mesentery of the intestine. Possible formation of pressure sores.

Other localizations of abdominal tuberculosis

Tuberculosis of the esophagus and stomach is relatively rare. The forms of defeat: ulcerative, stenosing and miliary. Patients complain of chest pain, dysphagia. With esophagoscopy, ulcers, hyperplastic granulations or scarring of ulcers with the development of stenosis are detected.

Tuberculosis of the stomach is manifested in the form of ulcerative, hypertrophic (tumor-like), fibro-sclerotic and mixed forms. In the early period of the disease, dull pain in the epigastric region, belching of the air, nausea, and a decrease in appetite are noted. In time, pyloric growth can develop. Diagnosis is confirmed by fluoroscopy, fibrogastroscopy with a histological examination of the biopsy, differential diagnosis is often performed with stomach tumors.

Tuberculosis of the liver is met in three forms: miliary, diffuse, less often - focal, type of tuberculosis. With a miliary form, typical tubercular granulomas are formed in the liver. Large caseous foci are encapsulated and calcified, and liver abscesses can form. Clinically, the lesion is manifested by jaundice, enlarged liver, splenomegaly. For the recognition of the disease, laparoscopy (laparotomy) is performed with taking a biopsy specimen and histological examination, tuberculosis of the gallbladder is considered a rare disease.

Tuberculosis of the spleen gives meager symptoms. Observe splenomegaly, subfebrile body temperature, ascites is possible. In the region of the spleen, calcinates are met.

Tuberculosis of the pancreas is rarely observed, it is usually detected on the section. No typical symptoms were found. Abdominal tuberculosis flows like chronic pancreatitis.