内科17intestinaltuberculosis2014ppt课件.ppt

Intestinal Tuberculosis(肠结核) Chen Xin Jie Department of Gastroenterology Zhu Jiang Hospital Useful words Bacillus tuberculosis(人型结核分枝杆菌) Mycobacterium bovis(牛型结核分枝杆菌) ileocecal region(回盲部) Intestinal fistula(肠瘘) Abscess(脓肿) Erythrocyte sedimentation rate (ESR,血沉) Exploratory laparotomy(剖腹探查) Introduction Incidence of Tuberculosis Acquired immunodeficiency syndrome (AIDS) （获得性免疫缺陷综合征） Multi-drug resistance Bacillus Tuberculosis (多重耐药结核分枝杆菌) Immunosuppressive agents (免疫抑制剂) Tuberculosis is back !! Etiology and Pathogenesis Pathogene Bacillus Tuberculosis(人型结核分枝杆菌) Mycobacterium bovis(牛型结核分枝杆菌) Route of Transmission Ingestion of bacilli in sputum from active pulmonary focus Ingestion of milk infected by Mycobacterium bovis Hematogenous spread from the primary lung focus Direct spread from adjacent organs Etiology and Pathogenesis The most common site of involvement The ileocecal region(回盲部) Increased physiological stasis Minimal digestive activity An abundance of lymphoid tissue Bacillus tuberculosis Mycobacterium bovis Human Tuberculosis? Structure of ileocecal region Appendix Cecum ileum Ascending colon ileocecal valve Endoscopic view of ileocecal region Endoscopic view of terminal ileum Pathology Ulcerative lesions(溃疡型) of Intestinal TB Chronic ulceration Intestinal fistula(肠瘘) Abscess(脓肿) Hypertrophic lesions (增生型) of Intestinal TB Intestinal obstruction(肠梗阻) Ulcerohypertrophic lesions(混合型) of ITB Clinical Presentations Abdominal pain Right lower quadrant pain ileocecal region Intestinal obstruction Diarrhea(腹泻) Ulcerative lesions Constipation(便秘) Hypertrophic lesions Abdominal mass Right lower quadrant Clinical Presentations Systemic symptoms (全身症状) Extraintestinal presentations (肠外表现) Fever, night sweat , weight loss, anemia,etc Active pulmonary tuberculosis Complications Intestinal obstruction Intestinal fistula Tuberculosis peritonitis(结核性腹膜炎) Bleeding Not common Laboratory Tests and Imaging studies Laboratory T