Tuberculosis of Abdomen: Everything

Introduction

The most common site involves is the an ileocecal region. The patient usually presents with abdominal pain, weight loss, diarrhea, obstructive complaints, etc.
One of the mechanisms of abdominal tuberculosis is to drink unpasteurized milk from cows infected with tuberculosis bacteria to ingest tuberculosis bacteria.
Abdominal tuberculosis can also occur through the spread of Mycobacterium tuberculosis in the blood from the lungs to the intestines. In two-thirds of children, the digestive system predominates. Abdominal cavity (peritoneum) involvement occurred in the remaining patients. Only the abdominal lymph glands are rarely involved.


Tuberculosis of Abdomen


What are the types?

Peritoneal tuberculosis
Intestinal tuberculosis
Tabes mesenteric
Renal tuberculosis
Pott's disease
Tuberculosis of fallopian tubes and ovaries
Tuberculosis of liver, stomach, etc.



What are the causes?

Drinking unpasteurized milk
Unhealthy food habit
Excessive taking of alcohol
Drinking impure water



What are the symptoms?

Intestinal tuberculosis

There are two divisions
Primary and Secondary

Primary tuberculosis
Especially in infants taking unpasteurized milk
Secondary T.B, Ulcerative colitis
Due to the less virulence of the organism and more resistance of the host, there is the formation of a granulomatous mass.

Symptoms
Pain in the right iliac fossa
Anorexia, nausea and vomiting, diarrhea.
Wasting and less marked evening rise of temperature.
Symptoms and signs of subacute intestinal obstruction, more marked.
Visible peristalsis of ladder pattern.
Fixed palpable mass in the right iliac fossa, tender and hard.
Barium meal follow-through of the ileocecal region may reveal a filling defect.


Secondary tuberculosis of intestine(ulcerative type)
Due to high virulence and low resistance of the host, there occurs necrosis, caseation and ulceration of the intestine.

Symptoms
Onset is gradual and progressive
Abdominal pain: Diffuse pain all over the abdomen sometimes located over the right iliac region or para-umbilical region. It is not related to the food taken. Colicky or cramping in nature and is partially relieved by vomiting or defecation.
Features of intestinal obstruction: Distention of abdomen, vomiting, constipation, increased borborygmic may be present.
Diarrheal symptoms: There may be alternating constipation and diarrhea.
Constitutional symptoms: Weakness, emaciation, anorexia, evening rise of temperature. 
Anemia marked emaciation, raise the temperature, tachycardia.



What is seen on examination?

Inspection: Bloated, visible small intestinal peristalsis(ladder pattern) may be present.
Palpation: Diffuse tenderness, maximum in the right iliac fossa, mass in right iliac fossa may be palpable, there may be muscle guard present.
Percussion: Increased tympanitic note.
Auscultation: Increased peristaltic sounds
Lungs may show evidence of tuberculosis.



Is abdominal tuberculosis contagious?

Yes, any form of tuberculosis is contagious. When it is in the abdomen, it can be spread to other abdominal organs.



Diet in Tuberculosis

The tubercular patient is knowing as a poor diet maintained patient. They may be in rich families, but their diet is poor or uncertain. Here below some diet advice for the tubercular patient:

Carbohydrate and Fats( Energy-rich foods): 
Whole grain cereals, millets
Vegetable oils, ghee, butter
Nuts and oilseeds. Sugars

Protein:
Pulses, nuts, and some oilseeds
Milk & milk products
Meat, fish, poultry

Minerals and Vitamins:
Green leafy vegetables
Other vegetables & fruits
Eggs, milk & milk products, and fresh foods



Complication

Hemorrhage
Fistula formation
Intestinal obstruction
Malabsorption



Investigation / Diagnosis

E.S.R raised
X.Ray chest may reveal active or healed lesions.
Ba-meal follow-through of the small intestine ad ileocecal region shows the rapid passage of barium where there is no obstruction.
Colonoscopy
Histological examination: Evidence of T.B in the resected intestine by colonoscopy.



Differential diagnosis

Crohn's disease
Amebiasis
Intestinal neoplasms



Treatment

General: Good nutritious diet, mainly liquids.
Exposure to sunlight.



Homeopathic medicines

Tuberculinum: Some specific symptoms indicate to bring tuberculinum. There are all gone sensations, hungry sensation, desire for milk, craving fr=or meat but it disagrees. Early morning sudden diarrhea, Stools dark brown.

Pulsatilla: In this medicine, the tongue coated with thick white fur. Thirstiness and putrid taste in the morning. Craving for lemonade and aversion to fats. Feeling of fulness one or two hours after the meals. Nausea and vomiting of undigested food.

Arsenicum album: Here we see inpatient, asthenic weakness and prostration. Restlessness and apprehension, midnight aggravation, burning pains.

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