Medicine in ten sentences

TB Abdomen 

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.


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