THE SYSTEM DISEASES OF THE DIGESTIVE SYSTEM : ABDOMINAL TB (TUBERCULOSIS PERITONEI) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Hematogenous dissemination of tubercle Bacillus, the spread of tuberculosis on the peritoneum from the bones of the pelvis, spine or of the uterus in women, finally, dissemination of tuberculosis by caseous reborn mesenteric lymph glands.
Symptoms depend on the anatomical changes in the peritoneum. There are exudative, adhesive and cases-ing forms, but these forms are often combined with one another. Main complaints : weakness, weight loss, pain of various nature in the stomach and its swelling, constipation, fever up to 38-38,5E; at the exudative form attached complaints about the increase in the abdomen. Objectively - paleness of the skin and visible mucous membranes, low power, feverish condition; at the exudative form is a steady increase in belly; its shape is not changed by the transition from a vertical to a horizontal position; percutere in the abdominal cavity is defined by fluid, not shifting when you change position. Palpation of the abdomen is painful. When adhesive and caseous forms with no exudate able to probe into the abdominal cavity of a separate seal, representing scar the modified gland and enlarged mesenteric glands.
For very long, with remissions. The formation of binding between the individual loops of the intestines can cause phenomena of partial intestinal obstruction, and sometimes interspersed ileus.
Recognition presents some challenges, especially when adhesive and caseous forms. Gradual onset, younger age of patients, nature of complaints and objective data, contact with tuberculosis patients and the detection of tuberculosis in the lungs or other organs facilitate recognition. In exudative forms of recognition helps the study of fluid produced by the permanent puncture of the abdomen. The presence of serous exudate containing Cytology lymphocytes, characteristic of tuberculous peritonitis. Differential diagnosis between tuberculous and cancerous peritonitis resolved by the finding of primary malignant tumors. X-ray examination of the gastrointestinal tract is required.
The prediction depends on the flow of primary tuberculosis. In some cases there is a cure; however, even with a favorable outcome in the abdominal cavity remains adhesive process that leads to the violation of motor and secretory activity of the intestine with subsequent development of inflammatory process.
Treatment is mainly conservative. Very useful is a restorative treatment, full dieticheskoe a diet containing large amounts of vitamins, prolonged stay in the air, especially in mountainous areas, physiotherapy - air baths, careful use of the sun, ultraviolet radiation, x-ray treatments.
Surgical treatment (laparotomy with subsequent irradiation of the abdominal cavity ultraviolet rays) gives a favorable immediate results. However, more long-term results give reason to be critical to this intervention, especially at the present time, when the use of streptomycin in combination with restorative treatment and physiotherapy gives, of course, more favorable results. If the belly extensive growths, leading to stenosis of the intestines or repetitive obstruction, surgical intervention is inevitable.