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PRESENTED BY : Sabita Poudel
B.sc nursing 2nd year
BPKIHS, DHARAN , NEPAL

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CONTENTS
Introduction to tuberculosis
Global burden
Brief Description of the disease
Pathogenesis
Routes of G.I tract infection
Clinical presentation
Differential diagnosis
Investigation
Medical management
Nursing management
 Potential complications

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INTRODUCTION
• Tuberculosis is a specific infectious disease
caused by Mycobacterium tuberculosis.
• Tuberculosis(TB) is an infectious disease that
primarily affects the lung parenchyma.

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• The disease also affects animals/ cattle and
known as Bovine tuberculosis which
may be sometimes transmitted to men.
• However it can also affect intestine
meninges bones joints, lymph glands .

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GLOBAL BURDEN
• The annual incidence of tuberculosis is nearly 8
million,with 2 million deaths worldwide .
• The total disease burden in India is estimated to
be more than 40% of the population
• It may involve the gastrointestinal tract,
peritoneum, lymph nodes or solid viscera, and
constitutes up to 12% of extrapulmonary TB
and 1%–3% of the total TB cases

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Definition
Abdominal Tuberculosis is a condition in which
there is tuberculous infection of the peritoneum
or other organs in the abdomen

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Robert Koch, a German Scientist who found
out the causative organism for
consumption and revealed his invention
in1882

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Gram negative bacillus –
Mycobacterium tuberculosis

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Abdominal tuberculosis is predominantly a
diseaseof young adults.
 Two-thirds of the patients are 21-40 yr old and
the sex incidence is equal, although some Indian
studies have suggested a slight female
predominance.

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The spectrum of disease in children is different
from adults, in whom adhesive peritoneal and
lymph nodal involvement is more common than
the gastrointestinal.

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Tuberculosis can involve any part of the
gastrointestinal tract.
Gastro intestinal tract is the sixth most
frequent site of extrapulmonary
involvement.

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The common site of involvement in the GI tract
are the ileum and the ileocaecal region,
possibly because of the increased physiological
stasis, increased rate of fluid and electrolyte
absorption, minimal digestive activity and an
abundance of lymphoid tissue at this site,
followed by the colon and jejunum.

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PATHOGENESIS
• . When the bacilli enter a suitable host, they are
transmitted through the airways to alveoli, where
they get deposited and start to multiply
• The body immune system initiates tissue reaction
resulting in the accumulation of exudates in
alveoli causing bronchopneumonia. This occurs 2
to 10 weeks after exposure
• Furthermore, the granulomas thus formed are
surrounded by macrophages and later get fibroid
with central soft portion called as Ghon’s
Tubercle.

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ROUTES OF G.I TRACT INFECTION
1.Hematogeneous spread from primary lung focus in
the childhood with later reactivation
2.Ingestion of bacilli in sputum from active
pulmonary focus
3.Direct spread from adjacent organs and
through lymph channel from infected nodes.

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The clinical presentation of abdominal
tuberculosis can be acute, chronic or acute on
chronic.
 Most patients have constitutional symptoms
of fever (40-70%)pain (80-95%),
diarrhoea (11-20%), constipation, alternating
constipation and diarrhoea, weight loss (40-
90%),anorexia and malaise.

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• Complication are:
Perforation
Fistula formation
Obstructive jaundice by compression of the
common bile duct.

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OESOPHAGEAL TUBERCULOSIS
• Oesophageal tuberculosis is a rare
entity,constituting only 0.2 per cent of cases
of abdominal tuberculosis.
• Oesophageal involvement occurs mainly by
extension of disease from adjacent lymph nodes.
• The patient usually presents with low grade
fever, dysphagia,odynophagia and an ulcer, most
commonly midoesophageal.

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GASTRODUODENAL
TUBERCULOSIS
• Stomach and duodenal tuberculosis each
constitute around 1 per cent of cases of
abdominal tuberculosis.
• Gastroduodenal tuberculosis may mimic peptic
ulcer.

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Symptoms
• Abdominal pain
• Fever
• Weight loss
• Abdominal distension
• Anorexia
• Alteration of bowel habits
• Vomiting
• Cough

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Signs
• Distension of abdomen
• Doughy abdomen
• Abdominal lump
• Mixed type (ascites, lump and diffuse peritonitis)
• Ascites
• Hepatomegaly
• Splenomegaly
• Hepatosplenomegaly
• Jaundice
• Pedal oedema

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• Complications: perforation fistulae
(pyeloduodenal, duodenocutaneous,
blind),excavating ulcers extending into pancreas
and obstructive jaundice by compression of the
common bile duct.

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GASTROINTESTINAL
TUBERCULOSIS
• Abdominal tuberculosis is usually secondary to pulmonary
tuberculosis, radiologic evaluation often shows no evidence of
lung disease
• The ileocecal region is the most common area of involvement
in the gastrointestinal tract due to the abundance of lymphoid
tissue.
• The natural course of gastrointestinal tuberculosis may be
ulcerative
hypertrophic or
ulcerohypertrophic.

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SEGMENTAL COLONIC
TUBERCULOSIS
• Segmental or isolated colonic tuberculosis refers
to involvement of the colon without ileocaecal
region, and constitutes 9.2 per cent of all
case as of abdominal tuberculosis.
• It commonly involves the sigmoid, ascending
and transverse colon.

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RECTAL COLONIC TUBERCULOSIS
• Clinical presentation of rectal tuberculosis is
different from more proximal disease.
• Haematochezia is the most common symptom
88%) followed by constitutional symptoms
(75%) and constipation(37%).
• The high frequency of rectal bleeding may be
because of mucosal trauma caused by scybalous
stool traversing the strictured segment.

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• Other manifestations of colonic tuberculosis
include fever, anorexia, weight loss and
change in bowel habits.
• The diagnosis is suggested by barium enema or
colonoscopy.

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DIFFERENTIAL DIAGNOSIS
• Crohn’s disease
• Chronic amoebiasis
• Roundworm infestation
• Lymphomas
• Larger bowel malingnancy.

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Colonies of Mycobacterium
tuberculosis Lowenstein-Jensen
medium

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INVESTIGATIONS
• Animal inoculation or culture of suspected
tissue resulting in growth of M.tuberculosis
• Histological demonstration of acid fast bacilli in
a lesion.
• Plain X-ray of the abdomen
• Laparoscopy
• Laparoscopic biopsy of tubercles found in the
peritoneum or other parts

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• Animal inoculation or culture of suspected
tissue resulting in growth of M.tuberculosis
• Histological demonstration of acid fast bacilli in
a lesion.

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• Radiological studies:Chest X-ray, Plain X-ray
abdomen, Small bowel barium meal, Barium
enema,
• Computed tomography
• Ultrasonography
• Colonoscopy
• Immunological tests:ELISA

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MANAGEMENT
Medical Management :
 Regimens included antitubercular therapy for 9
months with rifampicin, isoniazide and pyrazinamide
and for 2 months followed by rifampicin and isoniazide
for next 7 months.
• For patients with intestinal TB, some clinicians
administer corticosteroids routinely for the first 2
months of antitubercular treatment to decrease fibrosis
during the healing process.

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Surgical treatment
• The recommended surgical procedures today are
conservative.
• Strictures which reduce the lumen by half or more and
which cause proximal hypertrophy or dilation are treated
by strictureplasty.

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35. NURSING MANAGEMENT
• Preventing spreading of tuberculosis infection.
• Advocating adherence to the treatment regimen.
• Promoting activity and adequate nutrition.
• Proper preoperative and post operative care.
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ANY
QUESTIONS
???

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FOR YOUR KIND LISTENING
THANK YOU….