Tuberculous hepatitis
Last reviewed: 23.04.2024
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Tuberculosis hepatitis is usually found in autopsy or laparoscopy in patients with abdominal tuberculosis. Tuberculosis of the liver accompanies intestinal tuberculosis in 79-99% of cases.
Isolated liver damage is very rare, several anatomical formations are involved in a specific process at a time. However, in the clinical picture of the disease, the symptoms characteristic of the lesion of an organ predominate, which makes it possible to isolate the disease into an independent nosological unit.
Pathomorphology
Tuberculous mycobacteria penetrate the liver with hematogenous or lymphogenous pathways; it is also possible to spread the process along the bile ducts.
More often there are granulomatous specific hepatitis, milparny and focal tuberculosis of the liver, tuberculous cholangitis and tuberculous pylephlebitis. With a long course of tuberculosis, steatosis of the liver and amyloidosis develop.
The main morphological substrate is granuloma. After its disintegration, healing takes place without the formation of scar tissue, less frequent focal fibrosis and calcification.
Possible formation of pseudotumoral tuberculosis of the liver. Tuberculomas are white, non-uniform caseous masses surrounded by a fibrous capsule. Tuberculomas can be multiple.
Rare tuberculous cholangitis, caused by the ingress of caseous masses from the portal tracts into the bile ducts, is rare. Tuberculous pylephlebitis develops as a result of the breakout of caseous masses into the portal vein. As a rule, it quickly leads to death, although sometimes it can cause the development of chronic portal hypertension. Tuberculous lesions of lymph nodes in the portal of the liver in rare cases can lead to stricture of the bile ducts.
Symptoms of tuberculous hepatitis
Clinical manifestations of tuberculous hepatitis are more or less frequent. Patients may have anorexia, general malaise, weakness, excessive sweating, subfebrile condition, pain in the right upper quadrant. The liver is enlarged, its edge is dense, in some cases the surface is uneven (with granulomatous form) or it is possible to probe the node on its surface (tuberculoma). Often enlarged spleen.
Tuberculosis of the liver can also be a manifestation of miliary tuberculosis. The literature describes the development of fulminant hepatic insufficiency of tuberculosis etiology, including in patients undergoing hemodialysis treatment.
The clinical signs of tuberculous hepatitis are many-sided, pathognomonic symptoms are absent. It occurs, as a rule, under the mask of other diseases and is found only in some patients, and in most patients it remains unrecognized.
In modern conditions, tuberculosis of abdominal organs in children is observed against the background of general symptoms associated with intoxication.
Tubercular lesions of the liver can be manifested in the form of fever, jaundice, which occurs during severe miliary tuberculosis. In rare cases, multiple caseous granulomas result in massive hepatosplenomegaly and death of the patient from hepatic insufficiency.
In the blood serum, the albumin / globulin ratio decreases and the activity of alkaline phosphatase increases.
Liver involvement with extrahepatic tuberculosis
Chronic tuberculosis can be complicated by amyloidosis of the liver. Fatty degeneration of the liver can be caused by exhaustion and toxemia. After the end of treatment, jaundice may develop, especially when using isoniazid, rifampicin.
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Diagnosis of tuberculous hepatitis
In general, the diagnosis of tuberculous hepatitis is difficult. Tuberculomas in the liver are difficult to differentiate with lymphomas. A determining role in the diagnosis belongs to a liver biopsy. In addition, computed tomography can be used, in which lobed formation or multiple defects of filling in the liver and spleen are detected.
On the overview radiograph of the abdominal cavity, multiple or discrete hepatic petrics can be detected.
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