Abdominal TB

Abdominal TB

Abdominal tuberculosis is the 6th most common form of extra-pulmonary tuberculosis, and affects the –

gastrointestinal tract
spleen
pancreas
liver
peritoneum
omentum
lymph nodes near these organs.

What are the causes of Intestinal TB?

Due to a primary infection.

Due to reactivation of a dormant focus (post primary tuberculosis). The latter can happen due to decreased immunity levels due to HIV, severe infections, malnutrition etc.

Pathogens involved are Mycobacterium tuberculosis and Mycobacterium bovis.

Symptoms of Abdominal -Intestinal TB?

Fever

Loss of appetite

Fatigue

Weight loss

Constipation

Diarrhea

Colicky pain in the abdomen

Abdominal Swelling and tenderness

Night sweats

How TB reaches the Intestines?

Through blood

Direct contact with primary focus or

Ingestion of sputum containing bacilli from the active pulmonary focus.

What are the diagnostic tests for Intestinal TB?

Diagnosis of abdominal tuberculosis is usually clinical

Confirmed with following tests- all effective in reaching a conclusion with diagnosis.

Mantoux test
Liver Function Tests
ESR
Serum Albumin levels
X-rays show concomitant pulmonary lesions in less than quarter of cases
Ultrasound / CT scan abdomen
Barium Meal Assay
Endoscopy
Colonoscopy
Laparoscopy
Fine needle aspiration cytology
Peritoneal biopsy
Ascitic fluid assessment reveals straw coloured fluid with increased protein level, the serum ascites albumin gradient is less than 1.1 g/dl, and it is dominated by lymphocytes, and ADA-adenosine deaminase is above 36 U/l.
PCR assay and Quanti-Feron TB test

What are the Different Types of Intestinal TB?

Oesophageal Tuberculosis gives symptoms of dysphagia, mid oesophageal ulcer and odynophagia.

Gastro duodenal tuberculosis gives dyspepsia and obstruction in gastric outlet

Colonic tuberculosis gives Lower abdominal pain and haematochezia

Rectal and anal involvement gives annular rectal stricture and multiple perianal fistulae.

Peritoneal TB is of the following types

Ascitic: (Wet type)
- There is accumulation of fluid in the abdomen
- Abdomen is swollen
- Nodules of 1-2mm over the peritoneum

Obstructive: (Dry type)
- Adhesions seen over omentum and intestines.
- They become thick and rubbery.
- Leading to intestinal obstruction

Glandular:
- Affects mesenteric lymph nodes.
- Size becomes enlarged.
- The nodes are firm, less mobile and hard. Can be felt through the abdominal wall.
- Some ascites and obstruction can be present.

Abdominal Swelling and tenderness

Night sweats

What is the treatment of Intestinal TB?

Tuberculosis is curable with standardized treatment. For a new or fresh case of tuberculosis the ration of treatment is six to nine months, where for the first two to three months first line TB drugs are used like-

Rifampicin
Isoniazid.
Ethambutol.
Pyrazinamide
Streptomycin.
and for the next four months, three drugs –
- Rifampicin
- Isoniazid
- Ethambutol are used

Treatment is daily and adherence to TB treatment is critical for curing tuberculosis. If the treatment is not followed, the TB can come back or the TB bacteria can become drug resistant

Treatment regimens in special situations

The treatment of TB in special situations like in pregnancy and breastfeeding, liver disorders, and renal failure ,diabetes , HIV,alcoholism etc require modified treatment regimen

Treatment with Anti-tubercular drugs for at least six months ;
Depending on results to therapy, treatment continued for 12- 18 months.
Surgical treatment is conservative
- Stricturoplasty for correction for strictures
- Resection for perforations in the intestines
- Anastomosis is recommended for Intestinal obstruction

What are the pathological features of Intestinal TB?

Presence of transverse ulcers

Fibrosis

Thickening and stricturing of bowel wall

Enlarged lymph nodes

Matted mesenteric lymph nodes

Omental thickening

Abdominal TB

Abdominal TB

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