The document reviews the history and pathogenesis of gastrointestinal tuberculosis, describing how it has been recognized since ancient times. It examines the clinical manifestations and pathology of gastrointestinal tuberculosis across different organ systems. The conclusions emphasize that gastrointestinal tuberculosis remains an important public health issue that can mimic other diseases.
This document discusses abdominal tuberculosis, providing details on types, pathogenesis, clinical features, diagnosis and management. Some key points:
1. Abdominal TB can involve the gastrointestinal tract, peritoneum and pancreatobiliary system. It is most commonly seen in the ileocecal region.
2. The incidence and severity of abdominal TB is increasing with the HIV epidemic, as extrapulmonary TB is more common in HIV patients.
3. Diagnosis involves imaging like CT scans and ultrasound, as well as ascitic fluid examination, microbiological tests and colonoscopy. Laparoscopy may also be used.
4. Management consists of anti-tuberculosis drugs for 6-18 months
Abdominal tuberculosis is a common form of extrapulmonary tuberculosis, accounting for 3-4% of all tuberculosis cases. It most commonly involves the ileocecal region of the small intestine. Clinical presentations can include constitutional symptoms like fever and weight loss as well as abdominal pain. Diagnosis is challenging and relies on clinical suspicion combined with imaging findings and histopathological evidence from biopsies. Common investigative tools include barium studies, ultrasound, and colonoscopy. Treatment involves a standard antitubercular therapy regimen.
This document provides an overview of abdominal tuberculosis. It discusses that abdominal TB can involve any part of the gastrointestinal tract or surrounding areas. The most common forms are gastrointestinal TB, peritoneal TB, and TB of solid organs like the liver. Symptoms include abdominal pain, distension, and weight loss. Investigations include blood tests, ascitic fluid analysis, imaging, endoscopy, and laparoscopy. The standard treatment is 12 months of anti-tuberculosis medications. Surgery may be needed for complications like obstruction or perforation. Abdominal TB requires a high index of suspicion for diagnosis and treatment to reduce morbidity and mortality.
Abdominal tuberculosis is a form of extra-pulmonary tuberculosis that infects the gastrointestinal tract, peritoneum, and other intra-abdominal organs. It is classified into gastrointestinal tuberculosis, tuberculosis of the mesentery, peritoneal tuberculosis, tuberculosis of solid viscera, and miscellaneous types. Symptoms vary depending on involved organs but often include abdominal pain, weight loss, and fever. Diagnosis involves imaging, biopsy of affected tissues, and microbiological analysis of fluid samples. Treatment primarily consists of multidrug anti-tuberculosis therapy.
Abdominal manifestations in tuberculosis torfsMichaël Torfs
A 52-year-old man presented with dyspnea, fatigue, weight loss, diarrhea and a swollen right testis. Imaging showed hilar lymphadenopathy, a miliary pattern, mediastinal and hilar lymphadenopathy, pericardial effusion, splenomegaly with hypodense lesions, and micronodules in the lungs. A biopsy of the right testis revealed necrosis and acid-fast bacteria, leading to a diagnosis of disseminated tuberculosis. Tuberculosis commonly involves the abdomen and can affect lymph nodes, the peritoneum, gastrointestinal tract, liver, spleen, kidneys and genitals. Imaging plays a key role in the diagnosis and management of abdominal tuberculosis.
The document provides information about acute abdomen including potential causes, relevant history questions, physical exam findings, and management strategies. It discusses signs and symptoms of several specific conditions that can cause acute abdomen such as appendicitis, duodenal ulcer, kidney stones, abdominal aortic aneurysm, pancreatitis, cholecystitis, and bowel obstruction. The physical exam involves assessing vital signs, palpating the abdomen, and listening to bowel sounds while the management focuses on airway, nothing by mouth, and considering other potential causes like cardiac or gynecological issues.
Abdominal tuberculosis can involve the gastrointestinal tract, peritoneum, and pancreatobiliary system. It most commonly involves the ileocecal region due to abundant lymphoid tissue. Patients typically present with nonspecific abdominal pain, fever, weight loss, and alteration of bowel habits. Diagnosis is challenging as findings are nonspecific but may include ascites, lymphadenopathy, bowel wall thickening on imaging. Definitive diagnosis requires biopsy and culture of tissue, with ascitic fluid analysis also useful. Treatment involves a combination of antibiotics administered for at least 6 months. Surgery may be needed for complications like obstruction or fistulae.
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This document discusses abdominal tuberculosis, providing details on types, pathogenesis, clinical features, diagnosis and management. Some key points:
1. Abdominal TB can involve the gastrointestinal tract, peritoneum and pancreatobiliary system. It is most commonly seen in the ileocecal region.
2. The incidence and severity of abdominal TB is increasing with the HIV epidemic, as extrapulmonary TB is more common in HIV patients.
3. Diagnosis involves imaging like CT scans and ultrasound, as well as ascitic fluid examination, microbiological tests and colonoscopy. Laparoscopy may also be used.
4. Management consists of anti-tuberculosis drugs for 6-18 months
Abdominal tuberculosis is a common form of extrapulmonary tuberculosis, accounting for 3-4% of all tuberculosis cases. It most commonly involves the ileocecal region of the small intestine. Clinical presentations can include constitutional symptoms like fever and weight loss as well as abdominal pain. Diagnosis is challenging and relies on clinical suspicion combined with imaging findings and histopathological evidence from biopsies. Common investigative tools include barium studies, ultrasound, and colonoscopy. Treatment involves a standard antitubercular therapy regimen.
This document provides an overview of abdominal tuberculosis. It discusses that abdominal TB can involve any part of the gastrointestinal tract or surrounding areas. The most common forms are gastrointestinal TB, peritoneal TB, and TB of solid organs like the liver. Symptoms include abdominal pain, distension, and weight loss. Investigations include blood tests, ascitic fluid analysis, imaging, endoscopy, and laparoscopy. The standard treatment is 12 months of anti-tuberculosis medications. Surgery may be needed for complications like obstruction or perforation. Abdominal TB requires a high index of suspicion for diagnosis and treatment to reduce morbidity and mortality.
Abdominal tuberculosis is a form of extra-pulmonary tuberculosis that infects the gastrointestinal tract, peritoneum, and other intra-abdominal organs. It is classified into gastrointestinal tuberculosis, tuberculosis of the mesentery, peritoneal tuberculosis, tuberculosis of solid viscera, and miscellaneous types. Symptoms vary depending on involved organs but often include abdominal pain, weight loss, and fever. Diagnosis involves imaging, biopsy of affected tissues, and microbiological analysis of fluid samples. Treatment primarily consists of multidrug anti-tuberculosis therapy.
Abdominal manifestations in tuberculosis torfsMichaël Torfs
A 52-year-old man presented with dyspnea, fatigue, weight loss, diarrhea and a swollen right testis. Imaging showed hilar lymphadenopathy, a miliary pattern, mediastinal and hilar lymphadenopathy, pericardial effusion, splenomegaly with hypodense lesions, and micronodules in the lungs. A biopsy of the right testis revealed necrosis and acid-fast bacteria, leading to a diagnosis of disseminated tuberculosis. Tuberculosis commonly involves the abdomen and can affect lymph nodes, the peritoneum, gastrointestinal tract, liver, spleen, kidneys and genitals. Imaging plays a key role in the diagnosis and management of abdominal tuberculosis.
The document provides information about acute abdomen including potential causes, relevant history questions, physical exam findings, and management strategies. It discusses signs and symptoms of several specific conditions that can cause acute abdomen such as appendicitis, duodenal ulcer, kidney stones, abdominal aortic aneurysm, pancreatitis, cholecystitis, and bowel obstruction. The physical exam involves assessing vital signs, palpating the abdomen, and listening to bowel sounds while the management focuses on airway, nothing by mouth, and considering other potential causes like cardiac or gynecological issues.
Abdominal tuberculosis can involve the gastrointestinal tract, peritoneum, and pancreatobiliary system. It most commonly involves the ileocecal region due to abundant lymphoid tissue. Patients typically present with nonspecific abdominal pain, fever, weight loss, and alteration of bowel habits. Diagnosis is challenging as findings are nonspecific but may include ascites, lymphadenopathy, bowel wall thickening on imaging. Definitive diagnosis requires biopsy and culture of tissue, with ascitic fluid analysis also useful. Treatment involves a combination of antibiotics administered for at least 6 months. Surgery may be needed for complications like obstruction or fistulae.
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www.indiandentalacademy.com
This document discusses tuberculosis of the gastrointestinal tract. It can involve any part of the GIT from mouth to anus. Mycobacterium tuberculosis is usually the pathogen. It can spread hematogenously from a primary lung infection or by ingesting infected sputum. Imaging findings include thickening of the bowel wall, ulcers, strictures, and inflammation of lymph nodes. The most common sites of GI TB are the ileocecal region, colon, and stomach/duodenum. Imaging modalities like barium studies, CT, and ultrasound can demonstrate characteristic findings that help diagnose GI tuberculosis.
This document provides an overview of abdominal tuberculosis, including:
1) It describes the typical locations where tuberculosis infects in the gastrointestinal tract, most commonly the ileocecal region. It can spread through hematogenous, ingestion, direct contact, or lymphatic routes.
2) The clinical features include abdominal swelling, constitutional symptoms like fever and weight loss, and pain. Diagnosis involves tests like elevated ESR, positive Mantoux test, and high ADA levels in ascitic fluid. Colonoscopy may reveal mucosal nodules and ulcers.
3) Treatment involves antitubercular therapy for at least 6 months, though often longer, alongside potential surgery for obstructing lesions.
Abdominal tuberculosis can affect the gastrointestinal tract, peritoneum, mesenteric lymph nodes, liver and spleen. It most commonly involves the terminal ileum and ileocaecal junction. Patients typically present with non-specific symptoms like abdominal pain, fever, and weight loss. On examination, a mobile mass may be palpable in the right lower quadrant. Complications include obstruction, perforation, fistulae and strictures. Diagnosis involves biopsy of lesions to look for acid-fast bacilli or granulomas.
Perforated peptic ulcers commonly occur in middle-aged patients, often due to smoking and NSAID use. Symptoms include sudden severe abdominal pain. Diagnosis involves chest X-ray showing free air or CT scan. Treatment is surgical closure of the perforation along with antibiotics. Upper GI bleeding treatment involves resuscitation, diagnosis via endoscopy, and treatment of the bleeding source, such as ulcers. Gastric outlet obstruction is usually due to peptic ulcer disease or gastric cancer, causing non-bilious vomiting, weight loss, and metabolic abnormalities like hypochloremic alkalosis. Treatment involves rehydration, gastric decompression, investigation of the cause, and sometimes surgical gastroenterostomy.
This document summarizes gastrointestinal (GI) lymphomas. It discusses:
1. GI lymphomas account for 1-4% of all GI malignancies and are most commonly B-cell lymphomas. The major types are gastric and small intestinal lymphomas.
2. Gastric lymphomas are often marginal zone B-cell lymphoma (MALToma) or diffuse large B-cell lymphoma (DLBCL). MALToma has strong associations with Helicobacter pylori infection and can often be treated with H. pylori eradication therapy. DLBCL requires chemotherapy.
3. Small intestinal lymphomas include MALToma, DLBCL, mantle cell lymphoma, and Burk
The document summarizes tuberculosis (TB) pathology. It describes the bacteriology of Mycobacterium tuberculosis and M. bovis, which are common causes of TB. The pathogenesis of TB involves an initial inflammatory response followed by macrophage infiltration and formation of granulomas containing epithelioid cells and Langhans giant cells. TB lesions can be either productive or exudative depending on the organ involved. Microscopic findings include caseous necrosis surrounded by epithelioid and giant cells. TB can spread locally, via lymphatics or bloodstream to cause extrapulmonary or miliary disease. Organ involvement and response depends on factors like bacterial load, host immunity, and previous exposure.
Epidemiology and public health aspects of TB in indiaShyam Ashtekar
This document discusses tuberculosis (TB) in India from an epidemiological and public health perspective. It outlines the history of TB, noting that India shares 50% of the global TB burden. While drugs were developed in the 20th century, TB control programs in India have had limited success in reducing rates. India still sees around 2 million new cases annually. Environmental factors like poverty, overcrowding and malnutrition increase risk. Public health goals aim to reduce childhood TB infection rates by treating active cases and breaking transmission chains. Ongoing challenges include drug-resistant strains and the link between TB and HIV.
GASTRO INTESTINAL TRACT LYMPHOMAS AND PET CTArif S
GI lymphomas are most commonly non-Hodgkin's lymphomas involving the stomach and small intestine. Imaging plays an important role in staging GI lymphomas and identifying complications. On CT, GI lymphomas often appear as bulky masses or diffuse wall thickening, with preservation of the bowel wall layers. Mesenteric involvement frequently presents as multiple masses encasing blood vessels. Accurate diagnosis relies on biopsy.
This document provides information on Mycobacterium tuberculosis, the causative organism of cutaneous tuberculosis. It discusses the history, morphology, classification, epidemiology and pathogenesis of cutaneous tuberculosis. It describes various clinical types of cutaneous tuberculosis including lupus vulgaris, scrofuloderma, tuberculosis verrucosa cutis, primary inoculation tuberculosis, miliary tuberculosis, orificial tuberculosis and tuberculous gumma. It also discusses tuberculids, which are hypersensitivity reactions to M. tuberculosis. The document is a comprehensive overview of cutaneous tuberculosis.
This document describes the case of a 60-year-old female patient presenting with abdominal pain and distension. On examination, she showed signs of peritonitis. Investigations including ultrasound and x-ray revealed free fluid and free gas in the abdomen, suggestive of a hollow viscous perforation. She was diagnosed with a perforated peptic ulcer of the duodenum and underwent exploratory laparotomy and Graham's patch repair. Post-operatively, she improved with treatment and was discharged on the 12th day.
This is a presentation detailing facts about abdominal tuberculosis. Intended for healthcare professionals and medical students
Dr Manoj K Ghoda
Gujarat Gastro Group
The document discusses abdominal tuberculosis, presented by Dr. Sudhir Jain. It provides background on tuberculosis, noting it was historically called "consumption" and seen as a disease of artists that provided a painless death. Abdominal TB most commonly involves the ileocecal region and presents with abdominal pain, weight loss, and fever in young adults. Diagnosis relies on suggestive investigations and meeting criteria like histological evidence of caseating granulomas. Radiology may show features of peritoneal or intestinal involvement.
This document discusses perforated peptic ulcers. It first covers the surgical anatomy and blood supply of the stomach and duodenum. It then discusses the epidemiology, pathophysiology, risk factors, presentation, diagnosis, and treatment of perforated peptic ulcers. Key points include that perforations are more common in duodenal versus gastric ulcers and have a higher mortality rate for gastric ulcers. Risk factors include H. pylori infection, NSAID use, smoking, and Zollinger-Ellison syndrome. Patients typically present with sudden severe abdominal pain. Diagnosis involves upright chest x-rays showing free air. Treatment is surgical repair of the perforation.
Abdominal tuberculosis is the third most common form of extrapulmonary tuberculosis. It can affect any part of the gastrointestinal tract from mouth to anus. The most common sites of involvement are the ileocecal region and ascending colon. Patients typically present with abdominal pain, weight loss, fever, and diarrhea or constipation. Diagnosis is based on clinical features, imaging, endoscopy, histology, and culture of tissue samples. Treatment involves a 6-month course of anti-tubercular medications with surgery for complications like obstruction or perforation. A high index of suspicion is needed for early diagnosis and management of this potentially lethal but curable disease.
1) Genitourinary tuberculosis is a common form of extrapulmonary tuberculosis, accounting for 4% of the total TB disease burden. It commonly involves the kidneys, fallopian tubes, epididymis, and prostate.
2) Clinical presentations are non-specific and include recurrent urinary tract infections, irritative voiding symptoms, renal or epididymal masses, and infertility.
3) Diagnosis involves identifying the characteristic granulomatous lesions and caseous necrosis on biopsy of the involved organs, along with identifying the tuberculosis bacilli through microscopy or culture.
This document provides a detailed examination and classification of ulcers. It describes how to inspect an ulcer, including its size, shape, number, position, edge characteristics, floor, discharge, and surrounding area. It also covers how to palpate an ulcer, assessing tenderness, edge, base, depth, bleeding, and relation to deeper structures. A thorough examination can provide clues to diagnose specific ulcer types, such as tuberculosis, gummatous, or malignant ulcers.
This document provides information about renal tuberculosis, including its diagnosis and management. It begins with a brief history of tuberculosis and then focuses on renal tuberculosis. Key points include:
- Renal tuberculosis is most commonly caused by hematogenous spread from a pulmonary infection and presents with symptoms of urinary tract inflammation like dysuria, back/flank pain, or hematuria.
- Diagnosis involves urine analysis showing pyuria and sterile cultures, imaging like intravenous pyelography showing calcifications and abnormalities, and culture of urine or tissues.
- Radiological findings include calcifications, cavitary lesions, infundibular strictures, and evidence of destruction like a "putty kidney". Management involves antibiotic therapy but can be complicated
This document discusses cold abscesses, which are collections of pus that develop as a result of tuberculosis infection elsewhere in the body, most commonly the lymph nodes or bones. Cold abscesses are called such because they do not present with the typical signs of inflammation. The document outlines the pathogenesis of cold abscesses, their typical locations, clinical features, diagnostic testing including imaging and labs, and treatment approaches including anti-tubercular medications, aspiration or surgical drainage.
This document discusses tuberculosis of the gastrointestinal tract. It can involve any part of the GIT from mouth to anus. Mycobacterium tuberculosis is usually the pathogen. It can spread hematogenously from a primary lung infection or by ingesting infected sputum. Imaging findings include thickening of the bowel wall, ulcers, strictures, and inflammation of lymph nodes. The most common sites of GI TB are the ileocecal region, colon, and stomach/duodenum. Imaging modalities like barium studies, CT, and ultrasound can demonstrate characteristic findings that help diagnose GI tuberculosis.
This document provides an overview of abdominal tuberculosis, including:
1) It describes the typical locations where tuberculosis infects in the gastrointestinal tract, most commonly the ileocecal region. It can spread through hematogenous, ingestion, direct contact, or lymphatic routes.
2) The clinical features include abdominal swelling, constitutional symptoms like fever and weight loss, and pain. Diagnosis involves tests like elevated ESR, positive Mantoux test, and high ADA levels in ascitic fluid. Colonoscopy may reveal mucosal nodules and ulcers.
3) Treatment involves antitubercular therapy for at least 6 months, though often longer, alongside potential surgery for obstructing lesions.
Abdominal tuberculosis can affect the gastrointestinal tract, peritoneum, mesenteric lymph nodes, liver and spleen. It most commonly involves the terminal ileum and ileocaecal junction. Patients typically present with non-specific symptoms like abdominal pain, fever, and weight loss. On examination, a mobile mass may be palpable in the right lower quadrant. Complications include obstruction, perforation, fistulae and strictures. Diagnosis involves biopsy of lesions to look for acid-fast bacilli or granulomas.
Perforated peptic ulcers commonly occur in middle-aged patients, often due to smoking and NSAID use. Symptoms include sudden severe abdominal pain. Diagnosis involves chest X-ray showing free air or CT scan. Treatment is surgical closure of the perforation along with antibiotics. Upper GI bleeding treatment involves resuscitation, diagnosis via endoscopy, and treatment of the bleeding source, such as ulcers. Gastric outlet obstruction is usually due to peptic ulcer disease or gastric cancer, causing non-bilious vomiting, weight loss, and metabolic abnormalities like hypochloremic alkalosis. Treatment involves rehydration, gastric decompression, investigation of the cause, and sometimes surgical gastroenterostomy.
This document summarizes gastrointestinal (GI) lymphomas. It discusses:
1. GI lymphomas account for 1-4% of all GI malignancies and are most commonly B-cell lymphomas. The major types are gastric and small intestinal lymphomas.
2. Gastric lymphomas are often marginal zone B-cell lymphoma (MALToma) or diffuse large B-cell lymphoma (DLBCL). MALToma has strong associations with Helicobacter pylori infection and can often be treated with H. pylori eradication therapy. DLBCL requires chemotherapy.
3. Small intestinal lymphomas include MALToma, DLBCL, mantle cell lymphoma, and Burk
The document summarizes tuberculosis (TB) pathology. It describes the bacteriology of Mycobacterium tuberculosis and M. bovis, which are common causes of TB. The pathogenesis of TB involves an initial inflammatory response followed by macrophage infiltration and formation of granulomas containing epithelioid cells and Langhans giant cells. TB lesions can be either productive or exudative depending on the organ involved. Microscopic findings include caseous necrosis surrounded by epithelioid and giant cells. TB can spread locally, via lymphatics or bloodstream to cause extrapulmonary or miliary disease. Organ involvement and response depends on factors like bacterial load, host immunity, and previous exposure.
Epidemiology and public health aspects of TB in indiaShyam Ashtekar
This document discusses tuberculosis (TB) in India from an epidemiological and public health perspective. It outlines the history of TB, noting that India shares 50% of the global TB burden. While drugs were developed in the 20th century, TB control programs in India have had limited success in reducing rates. India still sees around 2 million new cases annually. Environmental factors like poverty, overcrowding and malnutrition increase risk. Public health goals aim to reduce childhood TB infection rates by treating active cases and breaking transmission chains. Ongoing challenges include drug-resistant strains and the link between TB and HIV.
GASTRO INTESTINAL TRACT LYMPHOMAS AND PET CTArif S
GI lymphomas are most commonly non-Hodgkin's lymphomas involving the stomach and small intestine. Imaging plays an important role in staging GI lymphomas and identifying complications. On CT, GI lymphomas often appear as bulky masses or diffuse wall thickening, with preservation of the bowel wall layers. Mesenteric involvement frequently presents as multiple masses encasing blood vessels. Accurate diagnosis relies on biopsy.
This document provides information on Mycobacterium tuberculosis, the causative organism of cutaneous tuberculosis. It discusses the history, morphology, classification, epidemiology and pathogenesis of cutaneous tuberculosis. It describes various clinical types of cutaneous tuberculosis including lupus vulgaris, scrofuloderma, tuberculosis verrucosa cutis, primary inoculation tuberculosis, miliary tuberculosis, orificial tuberculosis and tuberculous gumma. It also discusses tuberculids, which are hypersensitivity reactions to M. tuberculosis. The document is a comprehensive overview of cutaneous tuberculosis.
This document describes the case of a 60-year-old female patient presenting with abdominal pain and distension. On examination, she showed signs of peritonitis. Investigations including ultrasound and x-ray revealed free fluid and free gas in the abdomen, suggestive of a hollow viscous perforation. She was diagnosed with a perforated peptic ulcer of the duodenum and underwent exploratory laparotomy and Graham's patch repair. Post-operatively, she improved with treatment and was discharged on the 12th day.
This is a presentation detailing facts about abdominal tuberculosis. Intended for healthcare professionals and medical students
Dr Manoj K Ghoda
Gujarat Gastro Group
The document discusses abdominal tuberculosis, presented by Dr. Sudhir Jain. It provides background on tuberculosis, noting it was historically called "consumption" and seen as a disease of artists that provided a painless death. Abdominal TB most commonly involves the ileocecal region and presents with abdominal pain, weight loss, and fever in young adults. Diagnosis relies on suggestive investigations and meeting criteria like histological evidence of caseating granulomas. Radiology may show features of peritoneal or intestinal involvement.
This document discusses perforated peptic ulcers. It first covers the surgical anatomy and blood supply of the stomach and duodenum. It then discusses the epidemiology, pathophysiology, risk factors, presentation, diagnosis, and treatment of perforated peptic ulcers. Key points include that perforations are more common in duodenal versus gastric ulcers and have a higher mortality rate for gastric ulcers. Risk factors include H. pylori infection, NSAID use, smoking, and Zollinger-Ellison syndrome. Patients typically present with sudden severe abdominal pain. Diagnosis involves upright chest x-rays showing free air. Treatment is surgical repair of the perforation.
Abdominal tuberculosis is the third most common form of extrapulmonary tuberculosis. It can affect any part of the gastrointestinal tract from mouth to anus. The most common sites of involvement are the ileocecal region and ascending colon. Patients typically present with abdominal pain, weight loss, fever, and diarrhea or constipation. Diagnosis is based on clinical features, imaging, endoscopy, histology, and culture of tissue samples. Treatment involves a 6-month course of anti-tubercular medications with surgery for complications like obstruction or perforation. A high index of suspicion is needed for early diagnosis and management of this potentially lethal but curable disease.
1) Genitourinary tuberculosis is a common form of extrapulmonary tuberculosis, accounting for 4% of the total TB disease burden. It commonly involves the kidneys, fallopian tubes, epididymis, and prostate.
2) Clinical presentations are non-specific and include recurrent urinary tract infections, irritative voiding symptoms, renal or epididymal masses, and infertility.
3) Diagnosis involves identifying the characteristic granulomatous lesions and caseous necrosis on biopsy of the involved organs, along with identifying the tuberculosis bacilli through microscopy or culture.
This document provides a detailed examination and classification of ulcers. It describes how to inspect an ulcer, including its size, shape, number, position, edge characteristics, floor, discharge, and surrounding area. It also covers how to palpate an ulcer, assessing tenderness, edge, base, depth, bleeding, and relation to deeper structures. A thorough examination can provide clues to diagnose specific ulcer types, such as tuberculosis, gummatous, or malignant ulcers.
This document provides information about renal tuberculosis, including its diagnosis and management. It begins with a brief history of tuberculosis and then focuses on renal tuberculosis. Key points include:
- Renal tuberculosis is most commonly caused by hematogenous spread from a pulmonary infection and presents with symptoms of urinary tract inflammation like dysuria, back/flank pain, or hematuria.
- Diagnosis involves urine analysis showing pyuria and sterile cultures, imaging like intravenous pyelography showing calcifications and abnormalities, and culture of urine or tissues.
- Radiological findings include calcifications, cavitary lesions, infundibular strictures, and evidence of destruction like a "putty kidney". Management involves antibiotic therapy but can be complicated
This document discusses cold abscesses, which are collections of pus that develop as a result of tuberculosis infection elsewhere in the body, most commonly the lymph nodes or bones. Cold abscesses are called such because they do not present with the typical signs of inflammation. The document outlines the pathogenesis of cold abscesses, their typical locations, clinical features, diagnostic testing including imaging and labs, and treatment approaches including anti-tubercular medications, aspiration or surgical drainage.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
2. INTRODUCTION
x Tuberculosis (T.B.) has existed from the
very dawn of civilization.
x Records of TB in mummies were found in
Egypt as far as 5000 years ago.
(Cave, 1935)
3. x Extrapulmonary tuberculosis was
also known since antiquity.
x Pott’s disease was described in
paints and statues of ancient
Egyptians.
(Ghalioungy, 1958)
4. GASTROINTESTINAL TUBERCULOSIS
Tuberculous enteritis as a complication of
pulmonary T.B. was appreciated by Hippocrates in
the 5th century B.C.
Diarrhea attacking a
person with phthisis is a
mortal symptom
(Walsh, 1909)
5. GASTROINTESTINAL TUBERCULOSIS
Ebn Sina
The Famous Arab Scientist (980-1037)
in his book “Al-Kanoun”
described tuberculosis (Al-Sol) in details.
He described
q Abdominal distention
q Diarrhea
q Borborygmi
In late stages of the disease.
(Hunter, 1999)
6. GASTROINTESTINAL TUBERCULOSIS
PATHOGENESIS
x Mycobacterium tuberculosis is the pathogen in
most cases.
x Mycobacterium bovis in some parts of the world
with no pasteurization of milk.
x Mycobacterium avium intracellulare has become a
major pathogen in HIV patients.
(Nial et al., 1997)
7. PATHOLOGY
Most active inflammation in submucosa.
Bacill in depth of mucosal glands
Inflammatory reaction
Phagocytes carry bacilli to Peyers Patches
Formation of tubercle
Tubercles undergo necrosis
Portis (1953)
9. PATHOLOGY
Inflammatory process in submucosa penetrates to serosa
Tubercles on serosal surface
Bacilli reach lymphatics
Bacilli via lymphatics
Lymphatic obstruction Regional lymph nodes
of mesentery and bowel • Hyperplasia
→ Thick fixed mass • Caseation necrosis
• Calcification
(Boyed, 1943)
10. FORMS OF GI TB
Ulceroconstrictive Hypertrophic
60% of patients 10% of patients
Highly virulent Chronic
Mostly small Intestinal Mostly Ileocoecal
Mixed 30% of patients
(Howell & Knapton, 1964)
12. T.B. stenotic surgical segment with involvement of
mesenteric fat
Makram Milad, Cairo University
T.B. transverse girdle ulcer small
intestine
Makram Milad, Cairo University
13. Pathology of the previous ulcer
Sub mucosal muscular and
subserous granulomas
Makram Milad, Cairo University
T.B. Lymphadenitis
Makram Milad, Cairo University
14. GASTROINTESTINAL TUBERCULOSIS POSES A
DIAGNOSTIC PROBLEM
x The disease is not common.
x Not familiar to clinicians.
x Involves inaccessible sites.
x May be associated with other serious disorders, the
manifestations of which obscure or modify those of
T.B.:
HIV, Chronic Renal Failure, Diabetes Mellitus,
Liver Cirrhosis, Neoplastic disease.
(Kramer et al., 1990)
15. The approach to the subject
was directed to these main points.
x Country and continent of origin.
x Age
x Gender
x Associated HIV infection
x Associated pulmonary disease
x Constitutional signs and symptoms
x Signs and symptoms related to the site of
involvement in the G.I. tract
16. To achieve this aim
The following was carried on
x Search on the Pubmed was done for all abstracts since
1965.
x Original articles tackling the subject and available in
Egyptian libraries were collected
x Abstracts and original articles that describe symptoms
and signs related to gastrointestinal tuberculosis were
selected.
x Abstracts and articles were classified according to
organ involvement in the gastrointestinal tract.
x Retrieved data were pooled, tabulated and statistically
analyzed.
17. Demonstration photos were kindly
provided by colleagues; staff members of
Faculty of Medicine, Cairo University
19. Distribution of gastrointestinal tuberculosis
r
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nc
pa r y
lia
bi
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pa
to
cases (n=2204) by site
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lo
co
21
Site
n
lo
o co
ile e
tin
24
es
nt
li
al
sm
5
h
ac
om
st
s
gu
ha
op
es
4
0
50
40
30
20
10
Percent
20. India
23.9% Malaysia
6.5%
S. Africa
11.6%
USA
8.5%
Saudi Arabia
Others 11.7%
37.8%
Distribution of gastrointestinal
tuberculosis cases by country
21. S. America
1.1%
Australia
5.0% Asia
Europe 57.0%
13.9%
Africa
23.0%
Distribution of gastrointestinal
tuberculosis cases by continent
22. Children
2.0%
Adults
98.0%
Distribution of gastrointestinal
tuberculosis cases by age group
23. Male
41.8%
Female
58.2%
Distribution of gastrointestinal
tuberculosis cases by sex
24. Present
55.9%
Absent
44.1%
Distribution of gastrointestinal tuberculosis
cases reporting associated HIV
25. 120%
100%
80%
60%
40%
20%
0%
ry
n
l
h
ry
us
ta
lo
ac
ilia
ilia
ec
g
co
om
ha
ob
or
ob
o
op
Ile
ol
St
at
tic
C
Es
p
a
He
re
nc
Pa
Distribution of gastrointestinal tuberculosis
cases reporting associated HIV by site
27. 120%
100%
80%
60%
40%
20%
0%
n
ry
l
h
um
ry
us
ta
lo
ac
ilia
ilia
ec
g
co
ni
om
ha
ob
or
ob
o
o
rit
op
Ile
ol
St
at
tic
Pe
C
Es
p
a
He
re
nc
Pa
Distribution of gastrointestinal tuberculosis
cases reporting associated pulmonary
tuberculosis by site
28. 0% 5% 10% 15% 20% 25% 30% 35% 40%
Fever 35.6%
Wt. loss 34.1%
Anorexia 35.0%
Night sweats 5.0%
Distribution of gastrointestinal tuberculosis cases
reporting for associated general manifestations
30. Esophageal Tuberculous Nodules
Abdel Magid Kasem
Cairo University
Caseating Granuloma of the esophagus
Makram Milad
Cairo University
31. 0% 10% 20% 30% 40% 50% 60%
Ulcer dyspepsia 52.4%
Outlet obstruction 26.2%
Mass 19.0%
Haematemesis 11.9%
Fistula 2.4%
Local manifestations of gastroduedenal
cases (n= 42)
32. Diffuse narrowing of the body of the stomach
Calcified Lymph node.
Ba. Meal
Yehia Aly
Cairo University
33. Tuberculous mass in the stomach
Abdel Magid Kasem
Cairo University
Mucosal T.B. granuloma of the stomach,
Endoscopic biopsy
Makram Milad
Cairo University
Duodenal T.B. ulceration with narrow lumen
Mazen Naga
Cairo, University
38. 0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
pain 39.1%
rectal bleeding 21.8%
mass 12.1%
distention 9.0%
Local manifestations of colorectal cases
(n= 463)
39. Colonic T.B. polypoid mass. Colonic T.B. polypoid mass.
Colonoscopy Colonoscopy
Mazen Naga, Cairo, University Hunter, Cairo, University
40. 0% 20% 40% 60% 80% 100%
ascitis 90.6%
pain 59.9%
mass 23.7%
lymphadenopathy 3.4%
jaundice 3.4%
distention 2.0%
diarrhoea 1.0%
Local manifestations of peritonitis cases
(n= 881)
41. Peritoneal T.B.
Laparoscopy
Hunter, Cairo University
T.B. peritonitis
granulomata with fibrosis in
the omentum
Makram Milad
42. T.B. Peritoneal adhesions
Peritoneal T.B with adhesions Ultrasonography
Laparoscopy Zakareya Salama
Hunter, Cairo, University Cairo University
Calcified T.B lymph nodes
C.T. scan
Yehia Ali, Cairo, University
43. 0% 20% 40% 60% 80% 100%
jaundice 94.4%
pain 64.8%
Local manifestations of hepatobiliary cases
(n= 71)
44. T.B. adhesion around the gall bladder T.B. Liver abscess
Laparoscopy, C.T. scan
Hunter, Cairo University Yehia Aly, Cairo University
Hilar stricture due to porta hepatis
lymphadenopathy
Waheed Doss, Cairo University
45. 0% 10% 20% 30% 40% 50% 60% 70%
Abd.pain 60.9%
jaundice 17.4%
Local manifestations of pancreaticobiliary cases
(n= 86)
46. Tuberculous distal common bile duct stricture
(Tuberculous Pancreatic Mass)
Waheed Doss, Cairo University
47. SUMMARY
x Most publications on GI tuberculosis were in
the last decade.
x The publications were mainly from Asia.
x In the Western hemisphere, the disease is
mainly in emigrants from endemic areas.
48. SUMMARY
x Adults represent the majority of G.I. T.B. cases.
x The disease is slightly more prevalent in
females.
x HIV infection is a main risk factor.
x Pulmonary T.B. is a frequent but not an
essential association.
49. SUMMARY
x Patients present with nonspecific constitutional symptoms,
pyrexia and weight loss are the most common.
x Local manifestations depend on the site of G.I. tract affection:
q The esophagus: Dysphagia, fistula and haematemesis.
q The stomach and duedenum: ulcer-dyspepsia, outlet
obstruction and abdominal mass.
q The intestine: pain, diarrhea, perforation & abdominal mass
q The colon: pain and rectal bleeding.
q The peritoneum: ascites and abdominal distension.
q Hepato-pancreaticobiliary: pain and jaundice.
50. Gastrointestinal T.B.
Differential Diagnosis
Gastrointestinal T.B. should be considered in the
differential diagnosis of :
x Chronic diarrhea
x Malabsorption syndrome
x Abdominal masses
x Ascitis
x Inflammatory bowel disease particularly Crohn’s
disease.
x Gastrointestinal lymphomas
x Other GIT malignancies.
51. CONCLUSION
x Since 1980s, a resurgence of tuberculosis has
occurred.
x The disease is still and will remain a serious
public health threat worldwide
x Still the great mimicker, gastro intestinal
tuberculosis.
(Jadvar, 1997)
52. Do not fear to repeat what has already been said.
Men need most things dinned into
their ears many times and from all sides
mak THE FI
es th R
em p ST RUM
rick
up th OR
eir e
ars
THE SECOND registers
s
D enter
THIR
THE
(Rene Laennec, 1781-1826)
53. G.I. TUBERCULOSIS, A FINAL WORD
Be aware
of Abdominal Tuberculosis
(Bouma et al., 1997)