TB and typhoid lesions of small intestine .pptx

tb of small intestine

1. Typhoid and Tubercular lesions of small bowel Dr.Pushpalatha,MS Dept.of General Surgery GGH,Kadapa.

2. TB of SMALL INTESTINE Caused by rod shaped, acid fast bacilli - MYCOBACTERIUM TUBERCULOSIS. MODES OF SPREAD: Ingestion Hematogenous Lymphatics Retrograde spread Direct spread

3. ORDER OF FREQUENCY: ILEUM >CAECUM >ASCENDING COLON> JEJUNUM >APPENDIX>SIGMOID>RECTUM> DUODENUM > STOMACH>ESOPHAGUS. ILEOCECAL JUNCTION is most common because of: Abundance of Peyer's patches M cells Stasis - prolonged contact time Increased fluid and electrolyte absorption Minimal digestive activity

4. TYPES OF BOWEL TB: Ulcerative Hyperplastic There are two main forms of intestinal tuberculosis - Primary Secondary Hyperplastic caecal TB In primary TB predominant change is in mesenteric lymph nodes without any significant intestinal lesion. In secondary TB lesions are more prominent in intestine than lymph nodes. Secondary TB occurs in a patient of active pulmonary TB who swallows the sputum and the lesion develops in intestine. Hyperplastic caecal TB is a type of secondary TB where lesion is in the caecum and ascending colon and the lesion clinically presents as palpable mass.

5. Ulcerative type: Secondary form of ulcerative Virulent organism and poor body resistance (old age). Multiple Transverse Circumferential ulcers(GIRDLE ulcers). Caseation is common. Serosal is reddened and edematous. Most common in Terminal Ileum.

6. Hyperplastic type: Primary from of ulcerative Less virulent organism and good body resistance (young). Chronic and Granulomatous lesions. Caseation is not common (early nodal involvement). Establishes in lymphoid follicles. Most common site is Terminal Ileum and Ileocecal junction.

7. Clinical presentation : Colicky abdominal pain Anemia Loss of weight Loss of appetite Fever, malaise. Mass (Hard, nodular,non tender,non mobile). Ball of wind- rolling in abdomen,Borborygmi. Age : 25-50, both sexes.

8. COMPLICATIONS: Stricture Intestinal obstruction Malabsorption Perforation Fistula Blind Loop syndrome Cold abscess formation Haemorrhage

9. COLONOSCOPY:

10. PLAIN X -RAY ABDOMEN SHOWS: Calcified lymph nodes Dilated loops with multiple fluid levels Dilated terminal ileum Pneumoperitoneum (If perforated ulcer).

11. USG ABDOMEN: Thickened bowel wall Located ascites Lymph node enlargement Pseudokidney sign- ileocecal region pulled upto subhepatic region

12. PSEUDOKIDNEY SIGN-

13. MANAGEMENT: Medical therapy- only if there is no intestinal obstruction ATT- INH, Rifampicin,pyrazinamide,ethambutol- first line drugs. SURGICAL MANAGEMENT: Indications: Intestinal obstruction Acute abdominal presentation like perforation Severe haemorrhage Intra abdominal abscess formation and fistula formation

14. Typhoid lesions of small bowel