Tuberculosis of the digestive system

Tuberculosis of the digestive system Tuberculosis of the esophagus represents one of the rare localizations of this disease and in most cases is observed in persons with far-gone pulmonary forms shortly before death.

Etiology, pathogenesis. Tuberculous mycobacteria enter the esophagus during ingestion of infected sputum, with active tuberculosis of the larynx, epiglottis and pharynx, less often by lymphogenous or hematogenous pathways, as well as as a direct result of the tuberculous process from surrounding organs: bifurcation lymph nodes, spine, thyroid, larynx, Pharynx. Tuberculosis ulcers occur as a result of the caseous disintegration of tubercle tubercles. There are also miliary and stenosing forms of tuberculous lesion of the esophagus.

Symptoms, course. The disease can be asymptomatic, but more often its symptoms are obscured by more pronounced manifestations of tuberculous lesions of other organs (primarily the lungs and larynx) and the severe general condition of the patient.

The most striking symptom is dysphagia, which in the presence of ulcers of the mucosa can be accompanied by a sharp pain.

X-ray examination reveals large tuberculous ulcers and cicatricial narrowing of the esophagus.

The diagnosis facilitates esophagoscopy, biopsy, bacteriological examination of the material obtained from an ulcer.

The prognosis is determined by the severity of tuberculous changes in the lungs and other organs. Complications: fistulosis of the esophagus with trachea, bronchi, pleura, purulent mediastenitis; The breakthrough of the caseous cavity into a large vessel threatens profuse bleeding. When healing of tuberculosis ulcers, esophageal strictures are formed, its permeability is disturbed: as a result of the adhesive process between its bifurcation lymph nodes and the esophageal wall, its tractional diverticula are formed.

The treatment is carried out in specialized anti-tuberculosis hospitals. With tuberculous ulcers of the esophagus inward, additionally prescribed preparations of bismuth, local anesthetics. In cicatricial narrowing of the esophagus, bougie are carried out; In some cases, to maintain the patient's diet temporarily impose a gastrostomy.

Tuberculosis of the stomach is very rare, usually in the terminal phase of pulmonary tuberculosis. Recently, however, in patients with pulmonary tuberculosis, as a result of prolonged treatment with antituberculous drugs, "drug gastritis" is found.

Symptoms, course. The disease can occur asymptomatically or be accompanied by pain in the epigastric region, eructation, vomiting, a sharp decrease in appetite; As a rule, there is general exhaustion, fever, increased sweating.

The diagnosis of tuberculosis of the stomach is confirmed by X-ray examination and gastrofibroscopy. Therefore, a targeted biopsy is of particular value. In the study of gastric juice often reveals Achilles, in the gastric contents (more often in washing waters) are found mycobacterium tuberculosis.

The course and prognosis in most cases are determined by the severity of pulmonary and other localizations of tuberculosis. Rare complications are perforation of the tuberculous stomach ulcer, gastric bleeding, cicatricial stenosis of the pylorus.

Treatment is carried out in specialized tuberculosis hospitals. Patients with tuberculous lesions of the stomach are prescribed a sparing diet (table No. 1a-1) and symptomatic agents (as in the treatment of peptic ulcer of the stomach and duodenum).

Tuberculosis of the pancreas is very rare. Even in patients with active pulmonary tuberculosis, it is detected only in 0.5-2% of cases.

Symptoms, course. Patients complain of eructations, decreased appetite, nausea, pain in the upper left quadrant of the abdomen, often surrounding the character, diarrhea, increased thirst (in violation of the incremental function of the pancreas), progressive exhaustion, increased sweating, malaise, fever. Skin sometimes acquires a darkish color, as with addison's disease. When palpation of the pancreas, pain is noted in the place of its location.

Diagnosis. To confirm the diagnosis, echography, retrograde pancreatocholangiography, virsungography, scanning of the pancreas, examination of its external and internal secretion (characteristic deficiency of function) are carried out. Differential diagnosis is carried out with nonspecific pancreatitis, malignant and benign tumors of the pancreas.

Treatment is carried out in specialized anti-tuberculosis clinics. Assign also a fractional 5-6-feed, a sparing diet with a limited fat content, excluding acute foods and high protein content. With signs of exocrine insufficiency of the pancreas, enzyme preparations are prescribed, as in chronic pancreatitis.

Tuberculosis of the liver accompanies intestinal tuberculosis in 79-99% of cases. Tuberculous mycobacteria penetrate the liver with hematogenous or lymphogenous pathways, and possibly the spread of the process along the bile ducts. Most often observed miliary form or multiple tuberculomas of the liver with a caseous decay in the center. There are also nonspecific changes in the liver with pulmonary tuberculosis in the form of reactive hepatitis, fatty degeneration, amyloidosis or drug hepatitis (with prolonged use of tuberculostatic agents).

Symptoms, course. Anorexia, general malaise, weakness, increased sweating, subfebrile condition, pain in the right upper quadrant. The liver is enlarged, its edge is dense, in some cases the surface is uneven (with granulomatous form) or it is possible to probe the node on its surface (tu-berkuloma). Often enlarged spleen. To suspect a tubercular lesion of a liver it is possible in the event that at the patient a pulmonary tuberculosis is found out augmentation of a liver, the pain in right hypochondrium is marked.

The diagnosis is confirmed by laparoscopy, puncture liver biopsy, echography and scanning.

Treatment. To the anti-tuberculosis drugs, diet no. 5a and 5 are additionally prescribed; in case of a sharp violation of the liver function sirepare is administered.

Tuberculosis of the intestine is found in 60-90% of people who died of tuberculosis. Tuberculous mycobacteria enter the intestine most often by hematogenous or lymphogenous way or by ingestion of infected sputum, saliva and mucus, especially when tuberculous lesions of the larynx and pharynx. Most often the distal parts of the ileum and caecum are affected, appendix, rarely, ascending, transverse, colon.

Symptoms, course. Initially, tuberculous bowel disease can occur asymptomatically or with common symptoms - a violation of appetite, nausea and heaviness in the stomach after eating, weakness, malaise, subfebrile fever, increased sweating, swelling of the intestine. Unstable chair, little pain in the abdomen. Later the pain becomes more constant, it is localized more often in the right ileal region and near the navel, with palpation the dense painful thickening of the walls of the cecum and the terminal part of the ileum are determined. With lesions of the rectum, tenesmus and false desires are observed. With tuberculous mezadenitis, the pain is localized in the abdomen somewhat to the left and down from the navel or along the mesentery of the small intestine. During the X-ray study of the intestine, ulcers of the mucous membrane, dyskinetic phenomena, cicatricial stenoses, and sometimes defects in the filling of the cecum are detected. Lesion of the large intestine can be clarified with a colonoscopy. In the study of stool, positive reactions to latent blood and a test of a rebunal on a soluble protein are noted. In the blood - hypochromic anemia, leukopenia with relative lymphocytosis, with exacerbation - neutrophilic leukocytosis, an increase in ESR.

The course of intestinal tuberculosis in the absence of appropriate treatment is usually progressive. The prognosis is largely determined by the severity of tubercular lesions of the lungs and other organs. Complications: narrowing of the lumen of the intestine, perforation of tuberculous ulcers, peritonitis and intestinal bleeding.

Differential diagnosis is carried out with nonspecific enterocolitis, Crohn's disease, ulcerative colitis, cancer of the cecum.

Treatment. During an exacerbation, food is prescribed in the garbled form, fractional (4-5 times a day), rich in proteins, easily assimilated fats and vitamins. When the enzymatic processes are violated - preparations of digestive enzymes (abomin, panzinorm, etc.), multivitamins, iron deficiency anemia - parenteral iron preparations.