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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,Intestinal Tuberculosis and,Tuberculous Peritonitis,2020/4/25,1,Intestinal Tuberculosis and Tu,Section I,Intestinal Tuberculosis,2020/4/25,2,Section IIntestinal Tuberculos,Definition,Intestinal tuberculosis,(,肠结核,),is,a specific,chronic intestinal infection,caused by,mycobacterium tuberculosis,(,结核分枝杆菌,),.,Epidemiology,Most patients are young,female is more than male,2020/4/25,3,DefinitionIntestinal tuberculo,Etiology,?,Mycobacterium tuberculosis,2020/4/25,4,Etiology?Mycobacterium tubercu,Pathogenesis,1.Oral infection,pulmonary tuberculosis or laryngeal,（,喉,）,tuberculosis,drinking un-pasteurized milk,eating with patients,2. Hematogenous disseminated: miliary,（粟粒性）,tuberculosis,3.Direct spread of intra-abdominal tuberculosis,2020/4/25,5,Pathogenesis1.Oral infectionp,Pathology,?,Predilection site,：,ileocecal,(,回盲部,),ascending,colon, jejunum,(,空肠,),transverse colon,descending colon, appendix, duodenum and,sigmoid colon.,?,Pathological type,?,?,Ulcer type,Proliferative,(,增生,),?,Mixed,6,2020/4/25,Pathology?Predilection site：il,?,Ulcer type,Mycobacterium,lymphatic groups,local hyperemia,edema, inflammatory,exudate,tuberculosis,Caseous necrosis,ulcer,2020/4/25,7,?Ulcer typeMycobacteriumlympha,?,Proliferative,Tuberculous granuloma and,fibrous tissue proliferation,Hardening or thickening of bowel wall,intestinal stenosis,obstruction,?,Mixed,2020/4/25,8,?ProliferativeTuberculous gran,Clinical manifestations,?,Abdominal pain: right lower quadrant,relieve,after defecation,?,Diarrhea and constipation,:,ulcer-,diarrhea, fecal paste.,proliferative-,constipation,?,Abdominal mass,:proliferative,?,Other symptoms,：,TB toxemia, tuberculosis parenteral,performance,2020/4/25,9,Clinical manifestations?Abdomi,Complications,?,Intestinal obstruction,?,Fistula, abdominal abscess,?,Intestinal perforation, intestinal,bleeding,2020/4/25,10,Complications?Intestinal obstr,Laboratory and other tests,?,ESR, Hb, PPD (tuberculin skin test) positive or,strongly positive, T-spot,X-ray barium meal or barium enema examination,?,Stierlin,sign,?,Mucosa coarse, the mural margin just looks like,sawtooth, colon narrow,.,2020/4/25,11,Laboratory and other tests?ESR,2020/4/25,12,2020/4/2512,Colonoscopy,?,Mucosal,lesions,hyperemia,edema,ulcers,(,rat-bite-like,edges),or,nodular,masses,or,inflammatory,polyps,bowel,stenosis,.,?,Histological,examination:,caseous(,干酪样,),necrosis.,Mycobacterium,tuberculosis,.,2020/4/25,13,Colonoscopy ?Mucosallesions,hy,Ascending colon tuberculosis (ulcer-type,),Ulcer,2020/4/25,14,Ascending colon tuberculosis (,Ileocecal tuberculosis,Ulcer,Granulation hyperplasia,2020/4/25,15,Ileocecal tuberculosisUlcerGra,Diagnosis and differential diagnosis,Diagnosis,1.,Young,and,middle-aged,patients,with,parenteral,tuberculosis,2. Clinical manifestations,3. Colonoscopy,4.,PPD,test:,postive,5.,Biopsy,(caseating,granulomas),6.,Anti-tuberculosis,treatment,(2,to,6,weeks),effective,7.,Exploratory,laparotomy,(,剖腹探查,),2020/4/25,16,Diagnosis and differential dia,Differential diagnosis,?,Crohndisease,?,Colon,cancer,?,Amoebic,dysentery,?,?,Schistosomiasis,Others:,such,as,malignant,lymphoma,2020/4/25,17,Differential diagnosis?Crohnd,肠结核与,Crohn,病的鉴别,项目,肠外结核,病程,瘘管、腹腔脓肿、肛周,病变,病变节段分布,溃疡形态,活检,结核菌素试验,抗结核治疗,手术切除标本病理检查,2020/4/25,肠结核,多见,缓解与复发倾向不明显,少见,常无,常呈横行、浅表而不规则,抗酸杆菌阳性有助诊断,见干酪样肉芽肿可确诊,强阳性倾向肠结核诊断,症状明显改善、内镜所见改,善,/,好转,见干酪样肉芽肿可确诊,一般无,克罗恩病,缓解与复发倾向较明显,可见,有,多呈纵行、裂隙状,抗酸杆菌阴性,无干酪样肉芽肿,一般不呈强阳性,症状多无明显改善、内镜所,见无改善,均不见干酪样肉芽肿可排除,18,肠结核,肠结核与Crohn病的鉴别项目肠外结核病程瘘管、腹腔脓肿、肛,Treatment,?,Rest and nutrition,Standard antituberculosis treatment,Early,regularity,full course, appropriate amount,combination,Isoniazid,(,异烟肼,),pyrazinamide,(,吡嗪酰胺,),rifampin,(,利福平,),?,Surgical treatment,:,complete intestinal,obstruction, acute intestinal perforation, intestinal,bleeding, diagnostic difficulties,2020/4/25,19,Treatment?Rest and nutritionSt,Section 2,Tuberculous Peritonitis,2020/4/25,20,Section 2 Tuberculous Perito,Overview,?,Definition,It is a chronic diffuse peritoneal infection caused by,mycobacterium tuberculosis,Epidemiology,Most patients are young,female is more than male,2020/4/25,21,Overview?DefinitionIt is a chr,Etiology and pathogenesis,1.Etiology,Mycobacterium tuberculosis,2.,Infection,(1) Direct spread,Mesenteric lymph nodes, fallopian,tube,(,输卵管,),intestinal tuberculosis,(2) Hematogenous disseminated,Pulmonary,t,uberculosis,bone joints, testicular,(,睾丸,),tuberculosis , tuberculous,meningitis,(,多浆膜炎,),2020/4/25,22,Etiology and pathogenesis1.Eti,Pathology,?,Exudation,type,?,Adhesion type,?,Cheese type,2020/4/25,23,Pathology?Exudationtype?Adhesi,Clinical manifestations,?,Symptoms,?,TB toxemia -,fever, night sweats, weight loss, anemia,fatigue,?,Abdominal pain,-,lower quadrant, umbilicus(,脐周,),?,Diarrhea,?,Distention : ascites, sepsis, peritonitis, intestinal dysfunction,?,Abdominal signs,?,?,Abdominal tenderness or dough kneading sensation,(,柔韧感,),Abdominal mass,?,Ascite,2020/4/25,24,Clinical manifestations?Sympto,Complications,?,?,Intestinal obstruction,Fistula, intra-abdominal abscess,2020/4/25,25,Complications?Intestinal obst,Laboratory and other tests,1.ESR,2.PPD or T-SPOT positive or strongly positive,3.BUS:ascites,4.Ascites :exudate,lymphocyte predominance, ADA,bacterial culture,5. Abdominal plain film X-ray and gastrointestinal,barium meal examination,6.,Laparoscopic,(,腹腔镜,),peritoneal biopsy ,pathological,examination,2020/4/25,26,Laboratory and other tests1.ES,Diagnosis and differential diagnosis,Diagnosis,1.Young and middle-aged patients with tuberculosis,history,2. Clinical manifestations,3. Ascites,examination,4. PPD : postive,5. X-ray,6. Laparoscopic peritoneal biopsy,(caseating,granulomas,7. Anti-tuberculosis treatment (2 to 6 weeks) effective,2020/4/25,27,Diagnosis and differential dia,Differential diagnosis,Ascites,?,Intra-abdominal malignancy,?,Cirrhosis,?,Other diseases,Abdominal mass,-,Crohndisease, colon cancer ,abdominal tumor,Fever,-,Typhoid,(,伤寒,),Acute abdominal pain,-,Peptic ulcer perforation, acute,pancreatitis, acute cholecystitis,(,胆囊炎,),intestinal,obstruction,2020/4/25,28,Differential diagnosisAscites?,Treatment,?,Standard antituberculosis treatment,Early, regularity,full course, appropriate amount,combination,?,Ascites,2020/4/25,29,Treatment?Standard antitubercu,Treatment,?,Surgery,：,complete intestinal obstruction,acute intestinal perforation, some case of,fistulas, difficult diagnosis,2020/4/25,30,Treatment?Surgery：complete int,复习思考题,1,、试述肠结核的临床表现及诊断依据。,2,、结核性腹膜炎的诊断要点有哪些？,3,、结核性腹膜炎的腹水实验室检查有何特点？,4,、患者出现右下腹包块伴排便习惯改变应考虑,哪些疾病？,2020/4/25,31,复习思考题1、试述肠结核的临床表现及诊断依据。2、结核性腹膜,Thank you,2020/4/25,32,Thank you2020/4/2532,
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