What Is Intestinal Tuberculosis?

Intestinal tuberculosis is a chronic specific infection of the intestine caused by Mycobacterium tuberculosis (TMB). Mainly caused by human-type Mycobacterium tuberculosis. In a few areas, bovine-type Mycobacterium tuberculosis entero-tuberculosis occurs due to drinking unsterilized milk or dairy products. The disease is commonly seen in young and middle-aged people, with slightly more women than men.

Basic Information

English name: intestinal tuberculosis
Visiting department: Internal medicine
Multiple groups: Young women

Common causes: Human tuberculosis infection
Common symptoms: Abdominal pain, diarrhea and constipation, abdominal mass, burnout, weight loss, anemia, etc.

Causes of intestinal tuberculosis

More than 90% of intestinal tuberculosis is caused by human tuberculosis. In addition, drinking dairy products without strict disinfection can cause disease due to bovine tuberculosis. Intestinal tuberculosis infection can be caused by oral, bloodstream spread and tuberculosis of adjacent organs. . The onset of tuberculosis is the result of the interaction between the human body and tuberculosis bacteria. Obtaining infection through the above channels is only a condition for pathogenicity. Only when the number of invading tuberculosis bacteria is large, the virulence is strong, and the human body has abnormal immune function and intestinal dysfunction. Symptoms occur when local resistance is weakened.

Pathogenesis of intestinal tuberculosis

More than 90% of intestinal tuberculosis is caused by human-type Mycobacterium tuberculosis, and a few can be caused by bovine-type Mycobacterium tuberculosis. Intestinal infections caused by Mycobacterium tuberculosis are mainly intestinal, blood-borne and direct spread.

Intestinal

Mycobacterium tuberculosis mainly infects the intestine through oral infection. Patients often have open tuberculosis, which is caused by swallowing their own sputum containing mycobacterium tuberculosis. Or they often eat with patients with open tuberculosis and lack the necessary disinfection and isolation measures to cause the disease. In rare cases, drinking unsterilized milk or dairy products containing Mycobacterium tuberculosis can also cause primary intestinal tuberculosis. This is because, under normal physiological conditions, the contents of the intestine stay at the end of the ileum for a long time before passing through the ileocecal sphincter. In addition, the proximal colon often has anti-peristalsis, which makes the contents of the intestine stay longer in the cecum. In this way, mycobacterium tuberculosis has more opportunities to contact the intestinal mucosa, which increases the chance of infection of the intestinal mucosa. The ileocecal area is rich in lymphoid tissues, while Mycobacterium tuberculosis easily invades the lymphoid tissues.

2. When blood-borne miliary tuberculosis

Mycobacterium tuberculosis can cause intestinal tuberculosis by spreading blood.

3. Direct spread of intra-abdominal tuberculosis

Such as the direct spread of female genital tuberculosis and renal tuberculosis can cause intestinal tuberculosis.

Clinical manifestations of intestinal tuberculosis

Abdominal pain

Mostly located in the right lower abdomen, because intestinal tuberculosis occurs in the ileocecal area. There is often epigastric or umbilical pain, which is related to pain caused by ileocecal lesions, but physical examination at this time can still find the tender point in the right lower abdomen. Pain is mostly dull or dull. Sometimes meals can induce abdominal pain accompanied by bowel movements, which can be relieved to varying degrees after defecation, and abdominal cramps with intestinal obstruction, often located in the right lower abdomen or around the umbilicus, accompanied by abdominal distension, hyperactive bowel sounds, bowel type and peristaltic waves.

2. Diarrhea and constipation

Diarrhea is one of the main clinical manifestations of ulcerative intestinal tuberculosis. The number of bowel movements varies depending on the severity and extent of the lesions, generally 2 to 4 times a day, and more than 10 times a day in severe cases. Not accompanied by emergency. Feces are paste-like, generally do not contain mucus or pus, and in severe cases, they contain a small amount of mucus and pus, but stool blood is rare. Sometimes patients experience alternation of diarrhea and constipation, which is related to gastrointestinal disorders caused by the disease. Proliferative intestinal tuberculosis is mostly manifested as secretion.

3. Abdominal mass

It is usually located in the right lower abdomen, and is usually relatively fixed, with a medium texture and mild or moderate tenderness. Abdominal mass is mainly seen in proliferative intestinal tuberculosis. It can also be seen in ulcerative intestinal tuberculosis with localized peritonitis, adhesion of diseased intestinal segments and surrounding tissues, or mesenteric lymph node tuberculosis.

4. Systemic symptoms

It is more common in ulcerative intestinal tuberculosis, with long-term fever of different heat types, accompanied by night sweats. Patients with burnout, weight loss, anemia, and malnutrition manifestations such as vitamin deficiency as the disease progresses. Clinical manifestations of parenteral tuberculosis, especially active tuberculosis, can be present at the same time. Proliferative intestinal tuberculosis has a longer course, and the general condition is generally better. There is no fever or sometimes low fever, and most are not accompanied by extraintestinal tuberculosis.

5. In the absence of intestinal perforation, intestinal obstruction or peritoneal tuberculosis and other diseases, only the right lower abdomen and umbilical tenderness.

Intestinal tuberculosis examination

Blood test

Ulcerative intestinal tuberculosis may have moderate anemia, and white blood cell counts are usually normal without complications. The erythrocyte sedimentation rate (erythrocyte sedimentation rate) increases significantly, which can be used as one of the indicators to estimate the degree of tuberculosis activity.

2. stool test

The faeces of ulcerative intestinal tuberculosis are mostly paste-like, generally without gross mucus and pus, but a small amount of pus and red blood cells can be seen under the microscope. Feces are concentrated to look for Mycobacterium tuberculosis. Positive people can help diagnose, but it only makes sense if the sputum test is negative.

3. Tuberculin (PPD) test

A negative skin test or a positive blood PPD antibody is helpful for diagnosis, but a negative test does not rule out the disease.

4.X-ray inspection

X-ray gastrointestinal barium meal imaging is of great value in the diagnosis of intestinal tuberculosis. In the presence of intestinal obstruction, barium meal examination should be careful to avoid aggravating intestinal obstruction. Dilute barium can be used for inspection if necessary. In addition to barium meal examination, routine barium enema or colonoscopy should be performed to look for possible coexisting colonic lesions. In ulcerative intestinal tuberculosis, barium shows signs of irritation in the diseased intestinal section, emptying quickly and poor filling, and in the upper and lower intestinal sections of the disease, barium filling is good, called X-ray barium shadow jumping signs. If the diseased intestinal segment is full, the mucosal folds are rough, the edge of the intestinal wall is irregular, and sometimes jagged. It can also be seen that the bowel cavity narrows, the bowel segment shortens and deforms, and the normal angle of the ileum and cecum disappears.

5.CT inspection

Visible thickening of the intestinal wall, a small number of eccentric thickening of the inside of the cecum. This test is less sensitive than intestinal radiography.

6. Colonoscopy

Colonoscopy can directly observe the entire colon and the terminal ileum. If the lesion can be found, it is of great value in the diagnosis of this disease. The lesions were mainly in the ileocecal area. Endoscopic findings showed congestion and edema of the intestinal mucosa of the lesion, ulcer formation, inflammatory polyps of various sizes and shapes, and narrowing of the bowel cavity. A biopsy, if it can find caseous necrotizing granulomas or Mycobacterium tuberculosis, is of diagnostic significance.

7. Anti-tuberculosis antibody assay and mixed lymphocyte culture + interferon assay (T-Spot). T-sp ot detection has high sensitivity and specificity.

Intestinal tuberculosis diagnosis

Intestinal obstruction

It mainly occurs in proliferative intestinal tuberculosis and is seen in advanced patients.

2. Intestinal perforation

Mainly subacute and chronic perforation, can form abscess in the abdominal cavity, intestinal fistula after ulceration, intestinal bleeding is rare, occasional acute intestinal perforation. Complications associated with tuberculous peritonitis can occur.

Differential diagnosis of intestinal tuberculosis

Crohn's disease

The clinical manifestations, X-rays and endoscopic findings of this disease are often similar to those of intestinal tuberculosis and must be carefully identified. The main points of identification include: no evidence of parenteral tuberculosis; the tendency for remission and recurrence, the course of the disease is generally longer; although the lesions are found mainly on the terminal ileum on X-ray, other intestinal segments may be involved and present in a segmental distribution; more complicated fistula or anorectal lesions; antituberculosis drug treatment is ineffective; patients who have difficulty in clinical diagnosis and undergo laparotomy, there is no evidence of tuberculosis in resected specimens and surrounding mesenteric lymph nodes, that is, granulomatous lesions without caseous Necrosis, microscopy and animal vaccination were not found in Mycobacterium tuberculosis.

2. Right colon cancer

The disease is older than intestinal tuberculosis, often over 40 years old. No fever, night sweats, and other tuberculosis manifestations. X-ray examination mainly showed the filling defect of barium, and the lesion was limited to the colon. Colonoscopy and biopsy can confirm the diagnosis of colon cancer.

3. Amoebiasis or Schistosomiasis Granuloma

Has a corresponding history of infection. Pus and blood are common. Routine or hatchery inspection of the stool has revealed the pathogen. Colonoscopy is often helpful in differential diagnosis. The corresponding special effect treatment is effective.

4. Other intestinal tuberculosis

Sometimes it should be related to intestinal malignant lymphoma, Yersinia enteritis, and some rare infectious bowel diseases such as atypical mycobacteria (more common in AIDS patients), sexually transmitted lymphogranuloma, syphilis invasion of the intestine, and intestinal actinomycetes Disease identification. Fever as the main manifestation needs to be distinguished from long-term febrile diseases such as typhoid fever.

Intestinal tuberculosis treatment

The purpose of the treatment of intestinal tuberculosis is to eliminate symptoms, improve the general condition, promote healing of the lesion and prevent complications. Emphasis on early treatment because early lesions of intestinal tuberculosis are reversible.

1. Rest and nutrition

It can strengthen the patient's resistance and is the basis of treatment.

2. Anti-TB drugs

Is the key to the treatment of this disease. The choice, usage and treatment of drugs are the same as those of tuberculosis.

3. Symptomatic treatment

Anticholinergic drugs are available for abdominal pain. Insufficient intake or severe diarrhea should pay attention to correct water, electrolyte and acid-base balance disorders. For patients with incomplete intestinal obstruction, gastrointestinal decompression is required.

4. Surgery

Indications include: Complete intestinal obstruction; Acute intestinal perforation, or chronic intestinal perforation fistula formation that fails to close after medical treatment; Massive intestinal bleeding cannot be effectively stopped by active rescue; Difficult diagnosis requires a laparotomy .

Prognosis of intestinal tuberculosis

Before the emergence of anti-TB drugs, bowel tuberculosis has a poor prognosis and a high mortality rate. After the widespread application of antituberculosis drugs in the clinic, the prognosis of intestinal tuberculosis has been greatly improved, especially for mucosal tuberculosis, including intestinal tuberculosis. The prognosis of this disease depends on early diagnosis and timely treatment. When the lesion is still exuding, it can be completely cured after treatment, and the prognosis is good. The rational choice of anti-tuberculosis drugs to ensure adequate doses and treatment courses is the key to determining prognosis.

Intestinal tuberculosis prevention

Doing a good job of prevention is the fundamental way to prevent and cure tuberculosis. And focus on the discovery of extra-intestinal tuberculosis, especially the early diagnosis of tuberculosis and active anti-tuberculosis treatment, to make the sputum negative as soon as possible, so as to avoid swallowing sputum and causing intestinal infection. Health education on tuberculosis must be emphasized. Patients should be educated not to swallow sputum and to maintain smooth bowel movements. Health supervision should be strengthened, and meals with public chopsticks should be promoted. Milk should be sterilized. Inoculation with BCG vaccine can enhance the human body's resistance to tuberculosis bacteria and is conducive to preventing the occurrence of tuberculosis.