10 肠结核.ppt

1、Intestinal Tuberculosis(肠结核),Xin Jie Chen Department of Gastroenterology ZhuJiang Hospital,Useful words,Mycobacterium tuberculosis(结核分枝杆菌) Mycobacterium bovis(牛型结核分枝杆菌) ileocecal region(回盲部) Intestinal fistula(肠瘘) Abscess(脓肿) Erythrocyte sedimentation rate (ESR,血沉) Exploratory laparotomy(剖腹探查),Intro

2、duction,Incidence of Tuberculosis Acquired immunodeficiency syndrome (AIDS) （获得性免疫缺陷综合征） Multi-drug resistance Bacillus Tuberculosis (多重耐药结核分枝杆菌) Immunosuppressive agents (免疫抑制剂) Tuberculosis is coming back !,Aetiology and Pathogenesis,Pathogene Mycobacterium tuberculosis(结核分枝杆菌) Mycobacterium bovis

3、(牛型结核分枝杆菌) Route of Transmission Ingestion of bacilli in sputum from active pulmonary focus Ingestion of milk infected by Mycobacterium bovis Hematogenous spread from the primary lung focus Direct spread from adjacent organs,Aetiology and Pathogenesis,The most common site of involvement The ileoceca

4、l region(回盲部) Increased physiological stasis Minimal digestive activity An abundance of lymphoid tissue Mycobacterium tuberculosis Mycobacterium bovis,Human,Tuberculosis?,Structure of ileocecal region,Appendix,Cecum,ileum,Ascending colon,ileocecal valve,Structure of ileocecal region,Atlas of termina

5、l ileum,Pathology,Ulcerative lesions(溃疡型) of Intestinal TB Chronic ulceration Intestinal fistula(肠瘘) Abscess(脓肿) Hypertrophic lesions (增生型) of Intestinal TB Intestinal obstruction(肠梗阻) Ulcerohypertrophic lesions(混合型) of ITB,Clinical Presentations,Abdominal pain Right lower quadrant pain ileocecal re

6、gion Intestinal obstruction Diarrhea(腹泻) Ulcerative lesions Constipation(便秘) Hypertrophic lesions Abdominal mass Right lower quadrant,Clinical Presentations,Systemic symptoms (全身症状) Extraintestinal presentation (肠外表现) Fever, night sweat , weight loss, anemia,etc Active pulmonary tuberculosis Complic

7、ations Intestinal obstruction Intestinal fistula Tuberculosis peritonitis(结核性腹膜炎) Bleeding Not common,Laboratory Tests and Imaging studies,Laboratory Tests Anemia Erythrocyte sedimentation rate (ESR,血沉) Mushy stool Tuberculin test(结核菌素试验) +Protein purified derivative tuberculin (PPD) Barium meal exa

8、mination Intestinal obstruction Be careful ! Colonoscopy + biopsy,a.Multiple focal narrowings in the terminal ileum interspersed with stellate and linear ulcerations. b.A short stenosis in the terminal ileum,and a conical and shrunken cecum.,A. Two ulcers in the terminal ileum. B. A ulcer in the ile

9、ocecal region.,A,B,Diagnosis,Young adults with extraintestinal presentation of tuberculosis Right lower quadrant pain Diarrhea Abdominal mass Intestinal obstruction Night sweat Fever Findings of Barium studies,Diagnosis,Findings of Colonoscopy Tuberculin test(结核菌素试验) + Antituberculous therapy Effective Exploratory laparotomy(剖腹探查) Differential Diagnosis Crohns disease Colon carcinoma Amebiasis Others,Treatment,General treatment Antituberculous therapy KEY ! Sympt