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Tuberculosis of the abdomen


It commonly affect the ileocecal area (LQ 2012) in 70% of the cases. The other area involved are ascending colon, jejunum, appendix, sigmoid colon, rectum, duodenum, stomach and esophagus(in descending order of frequency).
Pathological types-
  1. Ulcerative (60%)-
    The long axis of the ulcer is perpendicular to the long axis of the GI segment involved hence it is prone for the stricture formation.
  2. Hypertrophic (10%)-
    1. Common in ileocecal region.
    2. Scarring, fibrosis, mass lesion mimicking carcinoma
  3. Ascitic type-
    1. Lymphatic spread from an intestinal focus lead to peritoneal involvement
    2. The fibroblastic bands and adhesions may obstruct bowel loops and produce features of subacute intestinal obstruction.
  4. Lympho glandular type-
    1. The predominant involvement is of mesenteric lymph nodes
Clinical features-
  1. Chronic pain abdomen is the most common presenting symptom (80-90%)
  2. Diarrhea
  3. Blood in the stools.
  1. Hemorrhage
  2. Perforation
  3. Obstruction
  4. Fistula formation
  5. Malabsorption
  1. Plain X-ray-
    1. Calcified lymph nodes
    2. Multiple air fluid levels
    3. Dilated bowel loops
  2. Barium meal/enema-
    1. Sterling sign- Failure of diseased segment to retain barium which is adequately retained by adjacent normal segment.
    2. String sign-thin segment of barium resembling a string in the terminal ileum.
  3. Ascitic fluid examination-exudative with lymphocytic predominance. Punch biopsy of the ascitic fluid reveals tubercular lesion.
  4. CT abdomen
  1. ATT for 6 months.
  2. Surgery if obstructive features are there.

Extra Edge Sterling and String sign are also seen in Crohn’s disease.

Intestinal pseudoobstruction
Primary – idiopathic, autosomal dominant, (due to myopathy or ANP)
Secondary – Scleroderma, SLE, DM, Hypothyroid, Parkinson, Phenothiazine, TCA  

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