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8/6/2019 Tuberculosis Peritoneum, Mesentry)
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TUBERCULOSIS (PERITONEUM, MESENTRY)
PRESENTED BY:- ASHARBH RAMAN
ROLL NO. 22
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TUBERCULOUS PERITONITIS
TWO TYPES:-
1. ACUTE TUBERCULOUS PERITONITIS.
2. CHRONIC TUBERCULOUS PERITONITIS.
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2. CHRONIC TUBERCULOUS PERITONITIS.
The condition presents with:-
A bdominal pain (90% of cases)
Fever (60%)
Loss of weight (60%)
A scites (60%)
Night sweats (37%)
A bdominal mass (26%).
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ORIGIN OF INFECTION
Infection originates from:-
Tuberculous mesenteric lymph nodes.
Tuberculosis of ileocaecal region.
A tuberculous pyosalpinx.
Blood-bourne infection from pulmonary tuberculosis,
usually the ¶miliary· but occasionally the ¶cavitating· form.
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VARIETIES OF TUBERCULOUS PERITONITIS.
There are four varieties of tuberculous peritonitis :-
A scitic
Encysted
Fibrous
Purulent
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ASCITIC FORM
The onset is insidious.
The peritonium is studded with tubercles and the
peritoneal cavity becomes filled with pale, straw colouredfluid.
There is loss of energy, facial pallor and some loss of
weight.
Pain is often absent, there is considerable abdominal
discomfort(associated with constipation or diarrhoea).
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On inspection, dilated veins may be seen coursing beneath
the skin of the abdominal wall.
On palpation, a transverse solid mass can often be
detected(this is rolled up greater omentum infiltrated with
tubercles).
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ENCYSTED FORM
It is similar to ascitic form except that one part of the
abdominal cavity alone is involved.
A localised intra-abdominal swelling is produced whichgives rise to difficulty in diagnosis.
Late intestinal obstruction is a possible complication.
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ENCYSTED FORM
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FIBROUS FORM
It is characterised by the production of widespread
adhesions.
This causes coils of the intestine, especially the ileum to
become matted together and distended.
The distended coils act as a blind loop and give rise to
steatorrhoea, wasting and attacks of abdominal pain.
The first intimation of the disease may be subacute or
acute intestinal obstruction.
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If the adhesions are accompanied by fibrous strictures of
the ileum as well, it is best to excise the affected bowel.
Small bowel bypass should be avoided to prevent
development of a ¶blind loop· syndrome.
A nti-tuberculous therapy will often rapidly cure the
condition without the need of surgery.
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PURULENT FORM
It is a rare form of peritonitis.
Usually it is secondary to tuberculous salpingitis.
Pus is present.
Siezable cold abscess often form and point on the surface,
commonly near the umbilicus, or burst into the bowel.
In addition to prolonged general treatment, operative
treatment may be necessary for the evacuation of cold
abscess.
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TUBERCULOSIS OF MESENTERIC LYMPH NODES
This is a rare entity and seen mainly in children.
Tubercle bacilli enter the mesenteric lymph nodes through
Peyer·s patches.
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V ARIOUS TYPES OF PRESENTATION OF THE
DISEASE :-
a) A s a cause of abdominal pain.
b) A s a cause of general symptoms.
c) A s a cause of intestinal obstruction.
d) Indistinguishable from appendicitis.
e) A s pseudomesenteric cyst.
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