Medicine in ten sentences
1. An extrapulmonary TB with concomitant pulmonary lesions in thirty pc of cases , transmitted via hematogenous route, unpasteurized bovine milk , swallowing infected sputum and from adjacent organs.
2. Intestinal TB : Most commonly affecting ileocecal area either ulcerative or hyperplastic variety manifesting as Abdominal pain, alternating bowel habits, bowel obstruction( hyperplastic variety ) , bloody diarrhoea with rarely massive GI bleeding, or a palpable mass( hyperplastic variety) with or without fever , malaise , weight loss as additional features.
3. Peritoneal TB : Ascites ( low SAAG High Protein with higher ADA(>40units /L) unless coexisting liver cirrhosis ) , Abdominal pain , bowel symptoms, fever. Jaundice if biliary involvement or lymph node obstruction. Crohns doesn't present as ascites unless advanced.
4. Solid organs : hepatic TB, Splenic TB. Isolated or disseminated.
5. Lymph node TB : large caseating granulomatous, Necrotic lymph nodes. This contrasts lymphoma which has homogenous lymph nodes.
6. High or normal ESR, Normal peripheral Leucocyte count , mantoux test ±, , sputum AFB ± . Chest Xray normal ( 70 pc cases) or opacities, cavities.
7. USG abdomen : isolated lesions in liver spleen, necrotic lymphadenopathy, mesenteric thickening, peritoneal thickening, ascites, right ileocecal mass.
8. Colonoscopy and biopsy: pulled up caecum, transversely oriented ulcer , large confluent caseating submucosal granulomas, lost patency of ileoceacal valve. Each feature contrast crohns disease.
9. Treatment : antitubercular drugs 6 months
10. Surgery : only indicated if complete bowel obstruction , nonresponding to medical therapy.