This document discusses genitourinary tuberculosis (GUTB), including its epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment. It provides an overview of tuberculosis infection in the kidneys, urinary tract, bladder, prostate, seminal vesicles, penis, and urethra. Diagnosis involves culture, nucleic acid amplification tests, histopathology, imaging like ultrasound and CT, and ureteroscopy. Treatment consists of medical therapy with anti-tubercular drugs for 6-12 months and potential surgical drainage, reconstruction, or resection in complicated cases.
Tuberculosis commonly involves the genitourinary tract. Genitourinary TB can affect any part of the urinary tract, including the kidneys, ureters, bladder, and genital organs. It typically presents with vague urinary symptoms like recurrent urinary tract infections that do not respond to antibiotics. Diagnosis involves identifying the tuberculosis bacteria in urine or tissue samples through smear, culture, or PCR tests. Imaging findings on IVU, CT, or MRI may demonstrate changes in the kidneys like calcification or destruction of the renal parenchyma. Prompt diagnosis and treatment are important to prevent long-term complications like renal failure.
Genitourinary tuberculosis is caused by Mycobacterium tuberculosis and commonly affects the kidneys, ureters, bladder and genitals. It spreads hematogenously from the lungs. Symptoms include dysuria, hematuria and flank pain. Diagnosis involves urine testing showing sterile pyuria and hematuria. Imaging like CT and IVU show lesions, calcifications and organ damage. Treatment involves multidrug antibiotic therapy for at least 6 months along with surgery for complications like strictures. Outcomes are good with early diagnosis and combined medical and surgical management.
This document discusses Genitourinary Tuberculosis (GUTB). It begins with the clinical history of GUTB and epidemiological data. It then describes the pathogenesis and clinical features of GUTB involving different organs like the kidneys, ureters, bladder, reproductive organs etc. It discusses the various investigations used for diagnosis of GUTB including urine examination, imaging modalities and microbiological tests. It also provides details of specific tests like tuberculin skin test, interferon-gamma release assays, culture tests and newer diagnostic techniques like PCR.
This document outlines recent advances in the management of liver cancers. It discusses the epidemiology, risk factors, classification, investigations and various treatment options for liver cancers including hepatic resection, ablation techniques, regional therapies, chemotherapy and transplantation. Resection remains the standard curative treatment for non-cirrhotic patients with localized disease, while ablation techniques and regional therapies are alternatives for patients not eligible for surgery. Advances in surgical techniques and anesthesia have improved resection outcomes.
Short review of genitourinary tuberculosisRavi7209
Genitourinary tuberculosis is caused by Mycobacterium tuberculosis infecting the genitourinary tract, most commonly from a primary lung infection. It accounts for 10-40% of extrapulmonary tuberculosis cases. Symptoms vary depending on the infected organ but may include persistent pyuria, hematuria, epididymal swelling, or prostatic/vesicle induration. Diagnosis is made by detecting acid-fast bacilli in urine samples. Treatment involves a standard 6 month antibiotic regimen, with surgery reserved for complications like obstruction or advanced scarring.
This document discusses the etiology, pathogenesis, and clinical features of genitourinary tuberculosis (GUTB). It begins with an overview of tuberculosis globally and then discusses specific topics related to GUTB, including microbiology, immunology, pathology of different genitourinary organs, and theories of pathogenesis. The kidneys and epididymis are typically the primary sites of GUTB infection, which then spreads contiguously to other genital organs. Clinical symptoms usually develop 10-15 years after primary pulmonary tuberculosis infection when dormant bacilli become reactivated due to immunosuppression.
The document discusses genitourinary tuberculosis (GUTB), including its pathogenesis, clinical presentations, diagnosis and diagnostic workup. Some key points:
- GUTB most commonly involves the kidneys and presents with irritative voiding symptoms in over 50% of patients. Diagnosis is made by identifying acid-fast bacilli in urine cultures or tissues.
- Diagnostic workup includes urine analysis, cultures, imaging like IVU or CT urography showing changes like calcifications, obstructions, and radiographic signs of early renal involvement.
- Definitive diagnosis requires one major criteria (histopathology showing granulomas, positive AFB or PCR) or two minor criteria
Lower gastrointestinal tract bleeding can be caused by various conditions affecting the colon and small intestine. The most common cause is diverticular disease, followed by hemorrhoids. Bleeding may present as hematochezia, melena, or occult bleeding resulting in anemia. Colonoscopy is the primary diagnostic tool for evaluating the source and managing bleeding, while other modalities like capsule endoscopy and angiography can also be used. Treatment depends on the underlying cause and may involve endoscopic therapies, medications, or surgery.
Tuberculosis commonly involves the genitourinary tract. Genitourinary TB can affect any part of the urinary tract, including the kidneys, ureters, bladder, and genital organs. It typically presents with vague urinary symptoms like recurrent urinary tract infections that do not respond to antibiotics. Diagnosis involves identifying the tuberculosis bacteria in urine or tissue samples through smear, culture, or PCR tests. Imaging findings on IVU, CT, or MRI may demonstrate changes in the kidneys like calcification or destruction of the renal parenchyma. Prompt diagnosis and treatment are important to prevent long-term complications like renal failure.
Genitourinary tuberculosis is caused by Mycobacterium tuberculosis and commonly affects the kidneys, ureters, bladder and genitals. It spreads hematogenously from the lungs. Symptoms include dysuria, hematuria and flank pain. Diagnosis involves urine testing showing sterile pyuria and hematuria. Imaging like CT and IVU show lesions, calcifications and organ damage. Treatment involves multidrug antibiotic therapy for at least 6 months along with surgery for complications like strictures. Outcomes are good with early diagnosis and combined medical and surgical management.
This document discusses Genitourinary Tuberculosis (GUTB). It begins with the clinical history of GUTB and epidemiological data. It then describes the pathogenesis and clinical features of GUTB involving different organs like the kidneys, ureters, bladder, reproductive organs etc. It discusses the various investigations used for diagnosis of GUTB including urine examination, imaging modalities and microbiological tests. It also provides details of specific tests like tuberculin skin test, interferon-gamma release assays, culture tests and newer diagnostic techniques like PCR.
This document outlines recent advances in the management of liver cancers. It discusses the epidemiology, risk factors, classification, investigations and various treatment options for liver cancers including hepatic resection, ablation techniques, regional therapies, chemotherapy and transplantation. Resection remains the standard curative treatment for non-cirrhotic patients with localized disease, while ablation techniques and regional therapies are alternatives for patients not eligible for surgery. Advances in surgical techniques and anesthesia have improved resection outcomes.
Short review of genitourinary tuberculosisRavi7209
Genitourinary tuberculosis is caused by Mycobacterium tuberculosis infecting the genitourinary tract, most commonly from a primary lung infection. It accounts for 10-40% of extrapulmonary tuberculosis cases. Symptoms vary depending on the infected organ but may include persistent pyuria, hematuria, epididymal swelling, or prostatic/vesicle induration. Diagnosis is made by detecting acid-fast bacilli in urine samples. Treatment involves a standard 6 month antibiotic regimen, with surgery reserved for complications like obstruction or advanced scarring.
This document discusses the etiology, pathogenesis, and clinical features of genitourinary tuberculosis (GUTB). It begins with an overview of tuberculosis globally and then discusses specific topics related to GUTB, including microbiology, immunology, pathology of different genitourinary organs, and theories of pathogenesis. The kidneys and epididymis are typically the primary sites of GUTB infection, which then spreads contiguously to other genital organs. Clinical symptoms usually develop 10-15 years after primary pulmonary tuberculosis infection when dormant bacilli become reactivated due to immunosuppression.
The document discusses genitourinary tuberculosis (GUTB), including its pathogenesis, clinical presentations, diagnosis and diagnostic workup. Some key points:
- GUTB most commonly involves the kidneys and presents with irritative voiding symptoms in over 50% of patients. Diagnosis is made by identifying acid-fast bacilli in urine cultures or tissues.
- Diagnostic workup includes urine analysis, cultures, imaging like IVU or CT urography showing changes like calcifications, obstructions, and radiographic signs of early renal involvement.
- Definitive diagnosis requires one major criteria (histopathology showing granulomas, positive AFB or PCR) or two minor criteria
Lower gastrointestinal tract bleeding can be caused by various conditions affecting the colon and small intestine. The most common cause is diverticular disease, followed by hemorrhoids. Bleeding may present as hematochezia, melena, or occult bleeding resulting in anemia. Colonoscopy is the primary diagnostic tool for evaluating the source and managing bleeding, while other modalities like capsule endoscopy and angiography can also be used. Treatment depends on the underlying cause and may involve endoscopic therapies, medications, or surgery.
1. Managing lymph node tuberculosis can be challenging as it has varied clinical manifestations and diagnostic challenges.
2. It most commonly involves cervical lymph nodes but can affect nodes throughout the body.
3. Diagnosis may involve imaging like ultrasound, CT, or MRI to identify enlarged or cystic lymph nodes, as well as biopsy to confirm the presence of Mycobacterium tuberculosis.
4. Treatment often requires a multi-drug antibiotic regimen over a prolonged period.
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.
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 changes in bowel habits. Diagnosis involves identifying caseating granulomas on biopsy or detecting Mycobacterium tuberculosis through smear, culture, or PCR of ascitic fluid or tissues. Treatment consists of a multi-drug antitubercular regimen for at least 6 months. Surgery may be needed for complications like obstruction or hemorrhage.
Liver abscesses occur when bacteria, protozoa, or fungi infect and destroy hepatic tissue. There are two main types: pyogenic (caused by bacteria) and amebic (caused by the protozoan Entamoeba histolytica). Common symptoms include fever, right upper quadrant pain, and hepatomegaly. Imaging tests like ultrasound and CT are used to detect abscesses. Treatment involves antibiotics, drainage of large abscesses, and treating any underlying infection. Outcomes are generally good but complications can include sepsis, empyema, and rupture.
This document discusses genitourinary tuberculosis (GUTB). It notes that GUTB can affect any part of the genitourinary tract, including the kidneys, ureters, bladder, and reproductive organs. Diagnosis is challenging as symptoms are often nonspecific, but may include hematuria, flank pain, and urinary symptoms. Diagnostic tests include urine culture and nucleic acid amplification tests, while imaging can identify features like calcifications. Proper treatment is important to prevent long term damage to the genitourinary system.
This document summarizes infectious diseases of the liver, focusing on pyogenic liver abscess and amebic liver abscess. Pyogenic liver abscess is usually polymicrobial, with risk factors including biliary tract disease, cirrhosis, and diabetes. Clinical features include fever, right upper quadrant pain, and jaundice. Treatment involves antibiotics and drainage of large abscesses. Amebic liver abscess is caused by Entamoeba histolytica and presents with nonspecific symptoms. Serology and imaging can help with diagnosis, and metronidazole is the treatment. Complications of liver abscesses include rupture, fistula formation, and spread to other organs.
The document discusses radiological approaches to diagnosing and evaluating urinary tract infections (UTIs). It begins by distinguishing between upper and lower UTIs, as well as uncomplicated and complicated UTIs. Common causative organisms of UTIs are also identified. Various imaging modalities are then described for evaluating UTIs, including intravenous urography, ultrasound, CT, MRI, and nuclear medicine scans. Specific radiological findings of acute bacterial pyelonephritis, chronic pyelonephritis, tuberculous infections of the urinary tract are also summarized.
Management of tb in ckd dr Tareq tantawyFarragBahbah
This document discusses the management of tuberculosis (TB) in patients with chronic kidney disease (CKD). It outlines that TB is more common in CKD patients due to factors like uremia and immunosuppression from dialysis or transplantation. It describes the clinical presentation of TB in CKD patients, which can be nonspecific, and challenges with diagnosis. It provides recommendations on screening CKD patients for latent TB and details dosing considerations for first- and second-line anti-TB drugs in renal impairment.
The 12-year-old girl presented with a cervical lymph node swelling and fever, and laboratory investigations revealed an elevated CRP and ESR along with a positive EBV IgM. Ultrasound-guided core biopsy of the lymph node showed features of histiocytic necrotizing lymphadenitis, and microbiological tests including CBNAAT and mycobacterial culture were negative, establishing a diagnosis of Kikuchi disease.
A liver abscess is a pus-filled mass inside or attached to the liver that is usually caused by an abdominal infection. While historically associated with high mortality rates, the introduction of surgical and percutaneous drainage techniques in the 1930s-1970s reduced mortality from 80% to 5%. Current treatment involves drainage via percutaneous or surgical methods along with antimicrobial therapy, though antimicrobials alone may be used for certain ill patients.
Peritonitis is inflammation of the peritoneum lining the abdominal cavity. There are several types depending on cause, including primary, secondary, and tertiary peritonitis. Primary peritonitis includes spontaneous bacterial peritonitis which occurs in those with cirrhosis and ascites. Secondary peritonitis results from infection spreading from a ruptured organ. Tertiary peritonitis is persistent or recurrent infection after source control of secondary peritonitis. Diagnosis involves ascitic fluid analysis and treatment involves antibiotics.
This document discusses tuberculosis through a series of case studies. It begins with an introduction to tuberculosis and its morphological features. It then presents 5 case studies involving different organ systems affected by tuberculosis including the lungs, intestines, lymph nodes, bones and brain. Each case provides clinical details, investigation results and gross pathological findings. The document discusses the diagnostic features of tuberculosis in these various organs. It provides images to illustrate primary pulmonary tuberculosis, miliary tuberculosis, intestinal tuberculosis and other forms. The document presents tuberculosis classifications and comparisons to other conditions like cancer.
Genitourinary Tuberculosis treatment and managemnt.pptxneeti70
Genitourinary tuberculosis (GUTB) usually results from the hematogenous spread of Mycobacterium tuberculosis from a primary pulmonary infection. Symptoms of GUTB are often masked by other conditions like UTIs, leading to delayed diagnosis. Resistant or recurrent UTIs should be tested for GUTB without delay. Diagnosis involves smear microscopy, mycobacterial culture, and tissue biopsy showing granulomatous inflammation. Treatment is a standard multidrug regimen for at least six months, sometimes longer for complex cases. Complications can include strictures, fistulas, renal impairment, and infertility if left untreated.
This document provides an overview of tuberculosis that affects the gastrointestinal tract. It discusses the global burden of tuberculosis, describing it as affecting nearly 8 million people annually with 2 million deaths worldwide. The document outlines the pathogenesis, routes of GI tract infection, clinical presentation including common symptoms, differential diagnosis, investigations used for diagnosis, medical and nursing management, and potential complications of gastrointestinal tuberculosis.
This document provides an overview of tuberculosis that affects the gastrointestinal tract. It discusses the global burden of tuberculosis, describing it as affecting nearly 8 million people annually with 2 million deaths worldwide. The document outlines the pathogenesis, routes of GI tract infection, clinical presentation including common symptoms, differential diagnosis, investigations used for diagnosis, medical and nursing management, and potential complications of abdominal tuberculosis.
Pyogenic and amebic liver abscesses can develop from a variety of causes. Ultrasound or CT imaging are used to identify abscesses, which appear as hypoechoic or low attenuation areas on scans. Treatment involves intravenous antibiotics along with drainage of larger abscesses via needle aspiration or catheter placement. For pyogenic abscesses, antibiotics are chosen based on culture results and typically include combinations targeting common bacteria. Amebic abscesses are generally treated with metronidazole or other nitroimidazole antibiotics, sometimes along with drainage or other antiparasitic drugs. Complications can arise if abscesses rupture or spread beyond the liver.
Tuberculosis is a chronic, wasting, communicable disease, which made a huge comeback with the HIV pandemic, making it an opportunistic infection, and and an AID-defining infection. This presentation explores the different types of tuberculosis in terms of their locations (pulmonary and extra-pulmonary) as well as in terms of their drug susceptibility. It also addresses the approach to the management of each one of these.
1) Tuberculous pleural effusion, a common extra-pulmonary manifestation of tuberculosis, results from the rupture of sub-pleural caseous foci into the pleural space or hematogenous spread.
2) Diagnosis involves analysis of pleural fluid and biopsy showing lymphocyte-dominant exudative fluid and granulomas in most cases. Adenosine deaminase levels greater than 70 U/L also suggest tuberculosis.
3) Treatment involves a standard short course of anti-tubercular therapy, which typically leads to resolution of symptoms and effusion within a few months without need for corticosteroids or surgery in most cases.
Choledochal cyst is a congenital anomaly involving cystic dilation of the bile ducts. It is classified into 5 types based on the location and extent of dilation. Type I is the most common. Imaging plays an important role in diagnosis and classification, with MRCP being the gold standard. Treatment involves complete excision of the cyst and Roux-en-Y hepaticojejunostomy. Complications include stones, malignancy, cholangitis and rupture. Caroli's disease is a rare disorder involving saccular dilation of intrahepatic bile ducts.
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)MuskanShingari
Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
Milan J. Anadkat, MD, and Dale V. Reisner discuss generalized pustular psoriasis in this CME activity titled "Supporting Patient-Centered Care in Generalized Pustular Psoriasis: Communications Strategies to Improve Shared Decision-Making." For the full presentation, please visit us at www.peervoice.com/HUM870.
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1. Managing lymph node tuberculosis can be challenging as it has varied clinical manifestations and diagnostic challenges.
2. It most commonly involves cervical lymph nodes but can affect nodes throughout the body.
3. Diagnosis may involve imaging like ultrasound, CT, or MRI to identify enlarged or cystic lymph nodes, as well as biopsy to confirm the presence of Mycobacterium tuberculosis.
4. Treatment often requires a multi-drug antibiotic regimen over a prolonged period.
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.
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 changes in bowel habits. Diagnosis involves identifying caseating granulomas on biopsy or detecting Mycobacterium tuberculosis through smear, culture, or PCR of ascitic fluid or tissues. Treatment consists of a multi-drug antitubercular regimen for at least 6 months. Surgery may be needed for complications like obstruction or hemorrhage.
Liver abscesses occur when bacteria, protozoa, or fungi infect and destroy hepatic tissue. There are two main types: pyogenic (caused by bacteria) and amebic (caused by the protozoan Entamoeba histolytica). Common symptoms include fever, right upper quadrant pain, and hepatomegaly. Imaging tests like ultrasound and CT are used to detect abscesses. Treatment involves antibiotics, drainage of large abscesses, and treating any underlying infection. Outcomes are generally good but complications can include sepsis, empyema, and rupture.
This document discusses genitourinary tuberculosis (GUTB). It notes that GUTB can affect any part of the genitourinary tract, including the kidneys, ureters, bladder, and reproductive organs. Diagnosis is challenging as symptoms are often nonspecific, but may include hematuria, flank pain, and urinary symptoms. Diagnostic tests include urine culture and nucleic acid amplification tests, while imaging can identify features like calcifications. Proper treatment is important to prevent long term damage to the genitourinary system.
This document summarizes infectious diseases of the liver, focusing on pyogenic liver abscess and amebic liver abscess. Pyogenic liver abscess is usually polymicrobial, with risk factors including biliary tract disease, cirrhosis, and diabetes. Clinical features include fever, right upper quadrant pain, and jaundice. Treatment involves antibiotics and drainage of large abscesses. Amebic liver abscess is caused by Entamoeba histolytica and presents with nonspecific symptoms. Serology and imaging can help with diagnosis, and metronidazole is the treatment. Complications of liver abscesses include rupture, fistula formation, and spread to other organs.
The document discusses radiological approaches to diagnosing and evaluating urinary tract infections (UTIs). It begins by distinguishing between upper and lower UTIs, as well as uncomplicated and complicated UTIs. Common causative organisms of UTIs are also identified. Various imaging modalities are then described for evaluating UTIs, including intravenous urography, ultrasound, CT, MRI, and nuclear medicine scans. Specific radiological findings of acute bacterial pyelonephritis, chronic pyelonephritis, tuberculous infections of the urinary tract are also summarized.
Management of tb in ckd dr Tareq tantawyFarragBahbah
This document discusses the management of tuberculosis (TB) in patients with chronic kidney disease (CKD). It outlines that TB is more common in CKD patients due to factors like uremia and immunosuppression from dialysis or transplantation. It describes the clinical presentation of TB in CKD patients, which can be nonspecific, and challenges with diagnosis. It provides recommendations on screening CKD patients for latent TB and details dosing considerations for first- and second-line anti-TB drugs in renal impairment.
The 12-year-old girl presented with a cervical lymph node swelling and fever, and laboratory investigations revealed an elevated CRP and ESR along with a positive EBV IgM. Ultrasound-guided core biopsy of the lymph node showed features of histiocytic necrotizing lymphadenitis, and microbiological tests including CBNAAT and mycobacterial culture were negative, establishing a diagnosis of Kikuchi disease.
A liver abscess is a pus-filled mass inside or attached to the liver that is usually caused by an abdominal infection. While historically associated with high mortality rates, the introduction of surgical and percutaneous drainage techniques in the 1930s-1970s reduced mortality from 80% to 5%. Current treatment involves drainage via percutaneous or surgical methods along with antimicrobial therapy, though antimicrobials alone may be used for certain ill patients.
Peritonitis is inflammation of the peritoneum lining the abdominal cavity. There are several types depending on cause, including primary, secondary, and tertiary peritonitis. Primary peritonitis includes spontaneous bacterial peritonitis which occurs in those with cirrhosis and ascites. Secondary peritonitis results from infection spreading from a ruptured organ. Tertiary peritonitis is persistent or recurrent infection after source control of secondary peritonitis. Diagnosis involves ascitic fluid analysis and treatment involves antibiotics.
This document discusses tuberculosis through a series of case studies. It begins with an introduction to tuberculosis and its morphological features. It then presents 5 case studies involving different organ systems affected by tuberculosis including the lungs, intestines, lymph nodes, bones and brain. Each case provides clinical details, investigation results and gross pathological findings. The document discusses the diagnostic features of tuberculosis in these various organs. It provides images to illustrate primary pulmonary tuberculosis, miliary tuberculosis, intestinal tuberculosis and other forms. The document presents tuberculosis classifications and comparisons to other conditions like cancer.
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Genitourinary tuberculosis (GUTB) usually results from the hematogenous spread of Mycobacterium tuberculosis from a primary pulmonary infection. Symptoms of GUTB are often masked by other conditions like UTIs, leading to delayed diagnosis. Resistant or recurrent UTIs should be tested for GUTB without delay. Diagnosis involves smear microscopy, mycobacterial culture, and tissue biopsy showing granulomatous inflammation. Treatment is a standard multidrug regimen for at least six months, sometimes longer for complex cases. Complications can include strictures, fistulas, renal impairment, and infertility if left untreated.
This document provides an overview of tuberculosis that affects the gastrointestinal tract. It discusses the global burden of tuberculosis, describing it as affecting nearly 8 million people annually with 2 million deaths worldwide. The document outlines the pathogenesis, routes of GI tract infection, clinical presentation including common symptoms, differential diagnosis, investigations used for diagnosis, medical and nursing management, and potential complications of gastrointestinal tuberculosis.
This document provides an overview of tuberculosis that affects the gastrointestinal tract. It discusses the global burden of tuberculosis, describing it as affecting nearly 8 million people annually with 2 million deaths worldwide. The document outlines the pathogenesis, routes of GI tract infection, clinical presentation including common symptoms, differential diagnosis, investigations used for diagnosis, medical and nursing management, and potential complications of abdominal tuberculosis.
Pyogenic and amebic liver abscesses can develop from a variety of causes. Ultrasound or CT imaging are used to identify abscesses, which appear as hypoechoic or low attenuation areas on scans. Treatment involves intravenous antibiotics along with drainage of larger abscesses via needle aspiration or catheter placement. For pyogenic abscesses, antibiotics are chosen based on culture results and typically include combinations targeting common bacteria. Amebic abscesses are generally treated with metronidazole or other nitroimidazole antibiotics, sometimes along with drainage or other antiparasitic drugs. Complications can arise if abscesses rupture or spread beyond the liver.
Tuberculosis is a chronic, wasting, communicable disease, which made a huge comeback with the HIV pandemic, making it an opportunistic infection, and and an AID-defining infection. This presentation explores the different types of tuberculosis in terms of their locations (pulmonary and extra-pulmonary) as well as in terms of their drug susceptibility. It also addresses the approach to the management of each one of these.
1) Tuberculous pleural effusion, a common extra-pulmonary manifestation of tuberculosis, results from the rupture of sub-pleural caseous foci into the pleural space or hematogenous spread.
2) Diagnosis involves analysis of pleural fluid and biopsy showing lymphocyte-dominant exudative fluid and granulomas in most cases. Adenosine deaminase levels greater than 70 U/L also suggest tuberculosis.
3) Treatment involves a standard short course of anti-tubercular therapy, which typically leads to resolution of symptoms and effusion within a few months without need for corticosteroids or surgery in most cases.
Choledochal cyst is a congenital anomaly involving cystic dilation of the bile ducts. It is classified into 5 types based on the location and extent of dilation. Type I is the most common. Imaging plays an important role in diagnosis and classification, with MRCP being the gold standard. Treatment involves complete excision of the cyst and Roux-en-Y hepaticojejunostomy. Complications include stones, malignancy, cholangitis and rupture. Caroli's disease is a rare disorder involving saccular dilation of intrahepatic bile ducts.
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Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
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2. • Introduction
• Epidemiology
• Clinical features and classification
• KUTB and GUTB
• Diagnosis
• Culture
• Imaging
• Urethrocystoscopy
• Treatment
• Medical
• Surgical
Genitourinary TB(Ibsa.D) 2
3. Epidemiology
• WHO 2013 – quarter world’s population is infected with MTBC in its latent form.
• Second great imitator after syphilis
• In developing countries 90 % of GUTB occurs and
• 15% to 20% with pulmonary TB
• the GU tract is the second most common extra pulmonary site after lymph
nodes
• In developed countries, GU TB has been found 27% of extrapulmonary cases.
• USA GU TB is the third most common form after pleural and lymphatic TB
• 2-10 of cases with pulmonary TB
• Male to female ratio(2:1)
• Mean age of affection is 40 years
Genitourinary TB(Ibsa.D) 3
4. Pathogenesis
• Latent TB is marked by cicatrization and
granuloma calcification.
• In fewer than 5% of primary progression
• Lifetime risk of reactivation TB is
estimated at 5% to 15%.
• the risk is higher in patients with the
medical comorbidities
Genitourinary TB(Ibsa.D) 4
5. GUTB development
• 1.Hematogenous spread-
• principal route
• active or latency
• 2.Ascending/retrograde infection
• Second route of infection
• BCG for treatment of Bladder cancer in 0.9%
• 3.Contiguous spread
• Extension from spine and
psoas
• Entero renal and entero
vesical fistula
• 4.Direct inoculation
• Very rare
Genitourinary TB(Ibsa.D) 5
6. Clinical features and classification
• Nonspecific sign and symptoms.
• 8.4% of GU TB patients are
asymptomatic
• The typical TB constitutional symptoms
of present in less than 20% of patients
• 50% of only dysuria
• 50% have storage symptoms
• 33% have hematuria and
• Renal colicky in 10%
• Typical laboratory findings include
sterile pyuria and/or hematuria is
found in more than 90% of GU TB
patients in developing countries
Genitourinary TB(Ibsa.D) 6
7. Clinical Classification of Urogenital Tuberculosis
kidney ( GUTB) nephron tuberculosis(Kulchavenya, 2014)
• KTB 1)
• TB of kidney parenchyma
• Occasional dx
• Nondestructive form is subject to
conservative therapy.
• CTX ( anti TB)
• KTB 2
• Small-destructive form
is subject to conservative therapy,
• Reconstructive surgery is indicated
for complications only.
• Unilateral or bilateral
• Solitary or multiple
KTB 3
• From parenchyma or papillitis
• Cavernous( subcortical cavern is like renal
carbuncle
• Poly-cavernous KTB and destruction from papiltis
• surgery indicated
• KTB 4
• Widespread destructive form recovery with anti-TB
drugs only is impossible,
• surgery is necessary, basically nephrectomy
•
Genitourinary TB(Ibsa.D) 7
8. 2.UTTB (urinary tract tuberculosis)
• TB of pelvis, ureters, bladder, and
urethra.
• Always secondary to KTB.
• Usually develops in the lower third
of ureter ,
• Strictures can also occur throughout
the ureter in a “pan-ureteral” fashion
leading to a “beaded corkscrew”
appearance.
• Urinary obstruction resulting from
strictures is an important cause of
renal failure in GU TB
Genitourinary TB(Ibsa.D) 8
9. Bladder
• Usually begins near the ureteral
orifices
• Implant in the urothelium and
cause a patchy cystitis.
• The dome of the bladder is the
most affected,
• whereas the trigone and neck usually
remain normal
• chronic inflammation and mucosal
scarring, bladder contracture develops
• Urinary frequency, urgency, pain, and
dysuria become prominent when bladder
capacity shrinks to less than 100 mL.
• The severely contracted “thimble”
bladder typically has a capacity of less
than 20 mL .
Genitourinary TB(Ibsa.D) 9
10. Kulchavenya, Divided bladder Tb in to 4 stages
• Stage 1- Tubercle infiltrative
• Stage 2- Erosive ulcerous
• Stage 3- Spastic cystitis
(bladder contraction , false
microcystitis) overactive bladder.
• Stage 4- Real microcytitis up to full
obliteration.
• The first two stages should be
treated by standard
anti-TB drugs,
• The third stage with standard
anti TB drugs and trospium
chloride.
• The fourth stage is indicated for
cystectomy with following
enteroplasty.
Genitourinary TB(Ibsa.D) 10
11. II. MGTB(male genital tuberculosis)
• TB epididymitis
• Unilateral ,can be bilateral in
34%
• Second most common site of
hematogenous seeding
• More affects the more
vascular globus minor
• Ulceration and tuberculous
sinus tract in 50 %
• Prostate TB (infiltrative or cavernous
forms);
• Hematogenous
• periphery and spare urethra
• Calcification and gland
hardening
• Urinary tract
• More affects the urethra and
manifests like bacterial
prostatitis
• Prostatic abscess in AIDS
patients
Genitourinary TB(Ibsa.D) 11
12. TB of seminal vesicles
• Cause of infertility
• Through urethra and also ejaculatory ducts
• Granulomas and further calcification
• Oligospermia,
• Azoospermia,
• Hematospermia.
• TB can rarely cause seminal vesicle abscesses
Genitourinary TB(Ibsa.D) 12
13. Penis and Urethra
• Involved in only 1.9% to 4.5% of GU TB
patients.
• Isolated urethral TB is very rare but has
been reported
• Urethral TB is usually associated with
prostate infection and complicated with
urethra cutaneous fistula (watering
pot perineum)
• Penile lesions begin on the skin as an
inflamed papule or a keratotic plaque (also
known as lupus vulgaris)
• ulcerate and spread to cavernous tissue
• these can be hard and mimicks malignancy and if
there is fibrosis penis can be distorted
Genitourinary TB(Ibsa.D) 13
14. •
Diagnosis
1.Culture
• Gold standard for the diagnosis of GU TB is urine acid fast bacilli (AFB)
culture.
• First-void urine is the best sample
• 3-5 urine samples on consecutive days
• The sensitivity is as high as 80% when done in this manner.
Genitourinary TB(Ibsa.D) 14
15. Cont …
• LJ (Lowenstein jansen) medium -Traditionally on solid , egg based
• Laborious and time consuming 4 to 6 weeks
• Middlebrook 7H10- Developed world in solid agar, based medium,
• Liquid based (BACTEC mycobacteria growth indicator tube (MGIT)
• Flouresence method detect MTB in as little as 10 days
• Current guidelines recommend culturing on at least one solid medium
concurrently with the liquid system to maximize yield
• ATB sensitivity to firsts line and second line can also be done
Genitourinary TB(Ibsa.D) 15
16. 2. NEUCLIC ACID AMPLIFICATION TESTS
• Providing results in 1 to 2 days
• Can detect in low bacillary load
• Sensitivity ranges from 87% to 96%
• Lower in non sputum specimens
• Urine contains natural inhibitors that interfere with DNA/RNA amplification
• 2010,WHO enthusiastically endorsed the newest TB PCR assay on the
market, the Gene-xpert MTB/RIF
• In small study EPTB 91 urine samples ( only 5 were culture positive) and
Gene expert was 100% sensitive and 98.6% specific
Genitourinary TB(Ibsa.D) 16
17. 3.Histopathology
• Caseating granulomas
• In patients with epididymal
nodules, fine-needle aspiration
cytology can provide a
diagnosis in 67.5% .
• Adding NAAT can further
augment diagnostic sensitivity to
tissue specimens
Genitourinary TB(Ibsa.D) 17
18. 4.Radiography
• GU TB generates a wide
spectrum of imaging findings.
• The test of choice depends on
disease location and should be
driven by symptoms and other
clinical data.
• Imaging is often the first test
that indicates TB is the cause
of a GU disorder
• Plain radiography
• IVU
• Retrograde pyelography
• Ultrasonography
• CT scan
• MRI
Genitourinary TB(Ibsa.D) 18
19. Plain radiography
• Calcifications- 50%
• Lobar pattern -pathognomonic
• Globular calcifications
• Triangular ring like calcifications for
papillary necrosis
• Cement or putty kidney: the calcific
rim outlines the renal lobes
• Renal and ureteral TB-infected
stones
• Kerr’s kink
• Bladder wall calcification
Genitourinary TB(Ibsa.D) 19
20. Intravenous urography
• GOLD standard in imaging
of early renal TB
• Loss of sharpness and
edge irregularities
• Calyceal erosions have a
‘Moth-eaten’ appearance
• Filling defect by
tuberculomas
• Phantom calyx
• Rigid, calcified,
straightened, pipestem
ureter
• Beaded corkscrew ureter
• Hiked up pelvis
• Obstructive changes
• Cloverleaf pattern,
calyceal dilation and
distortion
• Calyceal distortion
• Infindibular
narrowing
• Hydrocalycosis
• hydroureter
Genitourinary TB(Ibsa.D) 20
22. CT urography scan
• Replaced IVP
• Calcifications, scarring and signs of
obstruction
• Useful in evaluating patients with
complicated and extensive TB
• Les sensitive for detecting urothelial
thickening and subtle papillary necrosis
for which IVU is still preferred
• High dose of radiation
Genitourinary TB(Ibsa.D) 22
24. Ultrasonography
• Limited use in diagnosing GU
TB
• Primary use of US is for
following Hydronephrosis in
patients who are receiving
medical treatment
• fibrosis during healing can worsen
obstruction
• Pediatrics and pregnant
• Evaluate the testis, epididymis,
seminal vesicles,
• locate abscess and cavities
• Presence of ascites,LAP or omental
caking
Genitourinary TB(Ibsa.D) 24
25. Retrograde pyelography
• Replaced by CTU
• However when CT cannot be
done because of renal
insufficiency or contrast allergy,
• In addition can be used with IVU
to determine cavitation's are
obstructive or nonobstructive
• Useful in pediatric and pregnant
patients
• Sensitive than IVU in showing
caliectasis and urothelial thickingin
• DWI helps In distinguishing
pyonephrosis from HN
• MRU ureteral peristalisis
MRI
Genitourinary TB(Ibsa.D) 25
26. 5.Cytoscopy and
ureteroscopy
• Limited role Findings are
nonspecific
• Local hyperemia,
• Mucosal erosion,
• Ulceration,
• Granulomatous masses,
• Irrhole UO
• egularity of UO
• Golf
Genitourinary TB(Ibsa.D) 26
27. Treatment
• Medical therapy
• Combination therapy with first line ATDs
• Second line agents are reserved for
• Failed first line agents
• Side effects of first line agents
• Drug resistance for first line agents
• Treatment should start with these—namely, INH, rifampin, pyrazinamide, and
ethambutol.
• Before the start of treatment, baseline measurements should include blood
counts and liver and kidney function tests
Genitourinary TB(Ibsa.D) 27
28. Cont….
• Intensive phase(2 months): targeting for rapidly multiplying bacteria
• Continuation phase(6 months): to eradicate slow, sporadic multipliers
and persistent bacteria
• The role of steroid used in GUTB to prevent ureteral strictures and
bladder contraction,
• these are anecdotal and no clinical trials are further conducted
Genitourinary TB(Ibsa.D) 28
29. Duration of therapy
• Usually 6 months of standard short course therapy
• 9 months therapy is indicated in:
• Extensive pockets of infection
• Concurrent smear positive cavitary pulmonary disease
• CNS involvement
• Delay in positive cultures converting to negative
• If the patient is not taking Pyrazinamide for at least 2 months
• Some clinicians recommend treatment with 12 months of therapy
because of high relapse rates of 22% if given only for 6 months
29
Genitourinary TB(Ibsa.D)
30. • Surgical therapy
Optimal therapy for surgery is 4-6 weeks after initiation of ATDs
Operative management can be categorized in seven groups
1.Drainage for hydronephrosis (stenting or PCN insertion)1
2.Drainage for abscesses and caverns
3.Definitive local treatment of kidney tuberculosis(partial nephrectomy)
4.Reconstruction of upper UT
(calico/pyeloureterostomy, ureterolysis, ureterocystoneostomy, ureter
replacement)
5.Bladder augmentation
6.Reconstruction of urethra
7.Management of genital tuberculosis (epidiymorchidectomy)
Genitourinary TB(Ibsa.D) 30
31. 1. Drainage for hydronephrosis (stenting or PCN insertion)
• Should be done soon in uremia and
sepsis
• Stenting, reassess after 6 weeks
• Percutaneous
nephrostomy(PCN)
• Stenting retrograde is successful
in 41%
• If that fails antegrade stenting via
PCN
• PCN should be performed.
• Risk of tuberculous cutaneous
fistula during PCN removal.
• Avoid high contrast injection
pressures during stent or PCN
Genitourinary TB(Ibsa.D) 31
32. 2. Drainage for abscesses and caverns
• In septic cases drainage of the caverns of the kidney may be
necessary.
• Open surgical drainage of an abscess should not be attempted.
• The contents of an abscess should be aspirated in a minimally invasive
manner
Genitourinary TB(Ibsa.D) 32
33. 3. Definitive local treatment of kidney tuberculosis
• Nephrectomy indications
1.Nonfunctional kidney and recalcitrant
or recurrent TB despite optimal medical
therapy.
2. Nonfunctional kidney and medically
resistant hypertension.
• Partial nephrectomy indications
1. Localized polar lesion that failed to
respond to intensive CTX after 6 weeks
2.Area of calcification that is slowly
increasing in size and threatening to
destroy the whole kidney.
Genitourinary TB(Ibsa.D) 33
34. 4. Reconstruction of upper UT
Endoscopically or Open surgery
• Endoscopic management
• Upper and mid ureteric stricture
• Temporarily stenting for UPJ strictures
• Balloon dilation retrograde and antegrade access for UPJ,UVK and calyceal
infindibula
• Follow up needed
• High failure rates
• Steroid can be added
• If no improvement after 6 weeks open surgical treatment required
Genitourinary TB(Ibsa.D) 34
35. Open approach
• Dismembered pyeloplasty for
extrarenal pelvis
• Nondismebered pyeloplasty for
longer strictures but not feasible
because of excessive scarring
• Ureterocalicostomy (ureter to
lower pole of calyx)
• Upper and mid ureter- tension
free ureteroureterostomy
• Lower ureteric stricture-
ureteroneocystomy
• Psoas hitch— < 5cm
• Boari flap- 10 cm
• Ileal interposition in multiple
and recurrent strictures
Genitourinary TB(Ibsa.D) 35
36. 5.Bladder augmentation
1.Augmentation cystoplasty
(ileocecum or sigmoid segments
are most suitable)
• Indicated when frequency,
nocturia, urgency and pain and
hematuria intolerable
• Bladder capacity <100ml
• 2.Thimble bladder with <20ml
capacity best managed by
• orthotopic bladder substation
Genitourinary TB(Ibsa.D) 36
37. 6.Reconstruction of urethra
• Bladder neck contracture -transurethral incision of contracture
• Urethral strictures --endoscopically
• often require repeated procedures.
• Tuberculous urethral fistulae are treated by initiation of medical
therapy and suprapubic bladder drainage
• Delayed reconstruction is preferred
Genitourinary TB(Ibsa.D) 37
38. 7.Management of genital tuberculosis (epidiym orchidectomy)
• Extirpative surgery for genital TB is considered only for patients in
whom medical therapy has failed.
• When epididymis infected sparing the testis, every effort should be
performed to do epidymectomy without orchidecotmy
• If testis infected scrotal orchidecotmy can be done
• Involvement of the vas deferens by TB is usually distal to the external
ring and ligation of at the level of the ring is possible and sufficient.
Genitourinary TB(Ibsa.D) 38
40. 2.Articles and journals
1.Lenk S, Naber KG, Bishop MC, Johansen TEB, Botto H, Grabe M, et al. European Urology EAU Guidelines
for the Management of Genitourinary Tuberculosis Mete C. 2005;48:353–62.
2. Abbara A, Davidson RN. Etiology and management of genitourinary tuberculosis. Nat Rev Urol
[Internet]. 2011;8(12):678–88. Available from: http://dx.doi.org/10.1038/nrurol.2011.172
3. Çalışkan S. SM Gr up Diagnosis of Genitourinary Tuberculosis. 2016;1–8.
4. Carl P, Stark L. Indications for Surgical Management of Genitourinary Tuberculosis. 1997;505–10.
5. Kulchavenya E. Urogenital tuberculosis : definition and classification. 2015;1–6.
6. Merchant S, Bharati A, Merchant N. Tuberculosis of the genitourinary system - Urinary tract
tuberculosis : Renal tuberculosis – Part II. 2013;23(1).
7. Dhangar SP, Kothawala IH, Patil S, Kumar A, Whatkar A. Radiologic signs of genitourinary tuberculosis :
An aid for earlier diagnosis. 2016;1(4):1–8.
Genitourinary TB(Ibsa.D) 40
Editor's Notes
Initial mode of entry of MTBC into the host is via inhalation cough-generated infectious aerosols,
direct inoculation of MTBC into soft tissues
Bacilli reach the alveoli, they are phagocytosed by alveolar macrophages.
In some persons, MTBC organisms are killed by the macrophages at this point and effectively cleared
In others, MTBC bacilli escape killing, begin to replicate within macrophages, establish infection
Up to 12 weeks may pass before a cellular immune response is detectable and before this development the tubercle bacilli can spread through the lymphatics to the hilar lymph nodes and ultimately through the bloodstream to seed distant organs.
The two forms of TB described—latent TB infection and active TB disease—representa simplification of what is now understood to be a spectrum; adynamic continuum between contained TB infection, subclinicalTB disease, and progressively infectious TB disease.
Disseminated TB--high numbers of bacilli leads to innumerable small (3-mm), pale clumps of granulomas that look like scattered millet seeds on gross pathologic examination of the kidney
In the kidney, the “milia” can be found studding the renal cortex and medulla and do not usually affect renal function
localized infection of the kidney, tubercle bacilli become lodged first in the periglomerular capillaries.
Granulomas form in the renal parenchyma and coalesce.
When they caseate, cavities with necrotic material form.
result in frank abscesses, chronic pyelonephritis, and parenchymal and papillary necrosis. Sinus tracts may emerge along the flanks
As infection advances, the calyces become inflamed and eventually calcify, resulting in calyceal distortion, dilatation, and stenosis
An individual who has acquired TB can move forward and backward along this spectrum through his or her lifetime, depending on changes in hostimmunity such as imparted by medical comorbidities or changesin the bacilli such as imparted by treatment for latent TB infection
Hematogenous spread-prinicipal route, active or latency
Typical sites for GU seeding are kidneys and epididymis
Other organs of GUT is infected via contiguous spread from these initial landing
Ascending/retrograde infection
Second route of infection
BCG for treatment of Bladder cancer in 0.9
Contiguous spread
Extension from spine and psoas
Entero renal and entero vesical fistula
Direct inoculation
Very rare
Complications of nephrotuberculosis:chronic renal failure, fistula, high blood pressure.
KTB-2 may be unilateral and bilateral, solitary
and multiple. KTB-2 is often complicated by
UTTB. KTB-2 should be treated with anti-TB
drugs; if complicated, reconstructive surgery is
indicated. Prognosis is good, outcome is usually
recovery with fibrous deformation and post-TB
pyelonephritis. With inappropriate therapy KTB
has two routes of pathogenesis: from TB
of parenchyma or from papillitis. The first means
the development of a subcortical cavern without
connection to the collecting system. The clinical
manifestation of a subcortical cavern is like a
renal carbuncle, thus the diagnosis usually is
made after the operation. The second is the progress of the destruction of the papilla until cavern
development. Cavernous KTB may be unilateral
and bilateral, papillitis in one kidney and cavernous TB in another is usual; in this case the patient
should be treated as a patient with KTB-3.
Complications develop in more than half of the
patients. Full recovery by anti-TB drugs is
impossible, surgery is in general indicated. The
benefit outcome is the formation of a sterile cyst;
negative outcome is progress destruction until
polycavernous TB
TB should be suspected in patients with chronic prostatitis that persists despite antibiotics. Quinolones used to treat routine bacterial prostatitis are
also active against MTBC. However, the shorter courses used for
bacterial prostatitis are not sufficient for TB prostatitis, and the
symptoms will not resolve or will quickly recur. Prostatic abscesses
are rare but do occur, particularly in acquired immunodeficiency
syndrome (AIDS) patients
Orificial TB, a rapidly necrotic form of penile TB, has also been reported
It arises from autoinoculation of the penile skin with infected stool or urine from the patient, or rarely from hematogenous or lymphatic spread
Orificial TB is a presentation of very advanced and severe TB elsewhere in the GU or GI tract and carries a poor prognosis
The urethra appears somewhat resistant to TB infection and is involved in only 1.9% to 4.5% of GU TB patients.
It is typically associated with prostate infection and can manifest with urethroscrotal fistulae.
Isolated urethral TB is very rare but has been reported
Urethral TB is usually associated with prostate infection and complicated with urethrocutaneous fistula(watering pot perineum)
Other available detection methods include semiautomated systems
that use radiometric liquid culture. Antibiotic susceptibility can be
tested using any of the culture methods described earlier. Typically,
susceptibility to first-line TB drugs is tested “in house” with use of
the MGIT instrument. Susceptibility testing for second-line TB drugs
is generally performed only at reference laboratories.
Nonsputum specimens urine contain natural inhibitors that interfere with the DNA or RNA amplification process, potentially resulting in false-negative test results.
2010,WHO enthusiastically endorsed the newest TB PCR assay on the market, the gene xpert MTB/RIF
In general, nucleic acid amplification tests (NAATs) are frequently underused in developed countries because culture is necessary for drug susceptibility testing.
In developing countries, the cost
and the need for expensive equipment have been the obstacles.
Unlike cultures, NAATs cannot be used to monitor response to
treatment because nucleic acids are shed from dead organisms and
test results can remain positive despite adequate treatment
Papillary necrosis-triangular calcifications in the collecting system
Fibrotic autonephrectomy -small ,shrunken, calcified cement putty kidney
(calcific rims outline the individual renal is pathognomonic of ESRD) lobes,which
Renal and uretral TB infected calculi.
Stones may take strange shapes as deformed and fibrosed renal pelvis. upward arrowhead ,indicate renal pelvis that has been hiked up by contraction from scarring.
“hiked-up” renal pelvis, with sharp angulation of the ureteropelvic junction (UPJ), is known as “Kerr’s kink”
The IVU has been considered as one of the most useful tests for
obtaining anatomical and functional details of the kidneys [14]. It
can show a broad range of findings, depending on the severity
of infection. In a series of 45 patients, the IVU pointed to the
diagnosis of urinary TB in 88% [15]. However, approximately 10-
15% of patients who present with active renal TB may have
normal urographic findings
The earliest urographic change occurs in the minor calyces, with subtle initial signs such as minimal calyceal dilatation [5] and mild loss of calyceal sharpness due to mucosal edema [17] (Fig 3A,3B). As the disease progresses, the calyceal outline becomes more irregular, fuzzy, and ragged and, later, feathery and moth-eaten in appearance
Medullary cavities that communicate collecting system
Phantom calyx- whne calyx or infidibulum is stenosis,contrast excretion fails and creates
Uretral TB-rigid,calcifies,straightened pipestem uretet that is tubular and lacks peristalitic activity
Obstructive changes
Cloverleaf pattern, calyceal dilation and distortion
Hiked-up renal pelvis(when the pelvis is pulled from scaring) with UPJ kerr’s king(when acute angulation at UPJ)
TB papillary necrosis results
not only from ischemia, which is the basis of change in most
renal papillary necrosis, but also as a result of direct tissue
destruction. We have seen classic early forniceal and even
central papillary necrosis (Fig 3A, 3B) in numerous proven cases
of renal TB that cannot be differentiated from papillary necrosis
due to other causes.
. They result from a combination ofpapillary necrosis and parenchymal destruction. Typically,the papillae are involved first and this is followed by corticaldamage. Communication with the collecting system resultsin thickening, ulceration, and fibrosis – often with strictureformation
Treatment begins with an intensive phase of 2 monthsof daily INH, rifampin, and pyrazinamide, followed by a continuation phase of 4 months of INH and rifampin given daily, or alternatively thrice weekly
Although 6 months is the duration of standard short-coursetherapy, clinical scenarios regularly arise that require prolongationof treatment. Both the type of clinical disease present and the antituberculous drugs used affect duration of treatment
Monitor liver enzymes foer hepatic toxicity
Abstaind form alcohol and hepatotoxic drugs
Close follow uop recommended because to monitor side effects and renal lesion may worsen during treatment
Healing is accompanied by new fibrosis which cause urinary obstruction and bladder contraction
Steroids may help in the managent
Optimal timing of surgery is 4-6 weeks after initiation of medical therapy
Inflammation to subside
Bacillary load to decrease
Lesions to stabilize
A tuberculous cutaneous fistula can develop if the PCN is simply removed, although this is less likely to develop with effectiveconcurrent medical therapy.
High contrast injection pressures should be avoided during stent or PCN to prevent possible dessimintation of infection
total nephrectomy is considered in
two settings.
The first is the patient with a nonfunctional kidney and
recalcitrant or recurrent TB despite optimal medical therapy.
After
nephrectomy of the infected kidney, relapse rates of less than 1%
have been reported after short-course medical treatment (Figueiredo
and Lucon, 2008). The second setting in which a nephrectomy is
considered is the patient with a nonfunctional kidney and medically
resistant hypertension. Nephrectomy improves hypertension in 65% o
The length and degree ofthe stricture, whether it can be passed by a guidewire or not, vascularsupply to the lesion, and renal function are important factors to beconsidered in the management of patients
. In general, short strictures
with residual lumens in patients with good renal function yield
the best outcome. Strictures forming during medical treatment and
managed by early stenting (double-J placement) can stabilize and
require no further treatment (
Upper and middle ureteric strictures can be managed by excision
of the diseased segment, and, with adequate mobilization, a primary
tension-free ureteroureterostomy can be performed. Alternatively,
lysis of adhesions and intubation (Davis intubated ureterotomy) may
be done. Lower ureter strictures requiring surgery are best managed
by complete excision of the entire affected ureteric segment back to
healthy ureteric mucosa that has good blood supply. The resultant
gap is bridged with a tension-free, well-vascularized anastomosis to
healthy bladder (ureteroneocystostomy). Various procedures exist to
bring the bladder closer to the ureteric end. Simple mobilization
of the lateral attachments of the bladder on the contralateral side,
accompanied by dividing the superior vesical artery, may provide
2 to 3 cm of length to bridge a small gap. In patients with good
bladder capacity, a psoas hitch may also be performed. Care must be
taken to avoid the genitofemoral and femoral nerves when placing
these sutures. A well-performed psoas hitch can bridge a gap of up
to 5 cm. A Boari flap is another method of bridging a longer gap of
10 to 15 cm and may be performed in combination with a psoas
hitch (Sankari, 2007). A poorly executed Boari flap can compromise
bladder capacity. Contracted bladders from TB cystitis may not have
sufficient surface area and elasticity to allow flap creation. Finally,
ileal interposition (ileal ureteric replacement) can be done in cases
of multiple or recurrent strictures in which the native ureter is no
2.Thimble bladder with <20ml capacity best managed by
orthotopic bladder substation
Complication-
mucus production
Electrolyte derangements and
secondary bacterial infection