ABDOMINAL TUBERCULOSIS

ABDOMINAL
TUBERCULOSIS

BY:
sadhana shukla
Palak khanna
Madiha bano
 Introduction

Abdominal tuberculosis (TB) is defined as infection of the gastrointestinal tract,

peritoneum, abdominal solid organs, and/or abdominal lymphatics with
Mycobacterium tuberculosis.

Abdominal TB constitutes approximately 12% of extrapulmonary TB cases and 1 to

3% of total TB cases.

Abdominal TB is one of the most common forms of extrapulmonary TB. Abdominal

TB is relatively rare.

A high index of suspicion is necessary for early diagnosis of abdominal TB; however,
it remains a considerable diagnostic dilemma and can mimic many other diseases,
such as Crohn’s disease, abdominal lymphoma, and malignancy of the abdominal
organs.
Types
causes::
Abdominal tuberculosis

Complicated by perforation.
 Risk factors

 Risk factors for development of abdominal TB include :

 Mycobacterium tuberculosis
 Cirrhosis
 human immunodeficiency virus (HIV) infection
 diabetes mellitus
 underlying malignancy
 Malnutrition
 treatment with antitumor necrosis factor agents
 Corticosteroid
 use of continuous ambulatory peritoneal dialysis
 Clinical manifestation

 In order of frequency, abdominal tuberculosis manifests as tubercular lymphadenitis,

Peritonitis and Hepatosplenic or pancreatic tuberculosis.
 The clinical manifestations depend on the site and type of involvement.
 Fever and malaise
 Anemia
 Night sweats
 Loss of weight and weakness
 Abdominal pain
 Loss of appetite
 Diarrhea
 Bleeding Per rectum
 Hepatomegaly and splenomegaly
 Investigations
 Diagnosis can be confirmed by isolating the mycobacterium tuberculosis from the
digestive system by either a biopsy or endoscopy .
  Blood examination may show varying degree of anemia, leucopenia and raised ESR.
 Serum biochemistry: Serum albumin level may be low.
 PPD skin testing/mantoux test: (This gives supportive evidence to the diagnosis of
abdominal tuberculosis in 55 to 70% patients if positive, however, a negative tuberculin
test may also be observed in one-third of patients).
 Plain X-ray of abdomen and chest: Plain X-ray of abdomen (erect and supine films) is useful simple
investigation.
 Barium Studies: Barium contrast studies are useful for the diagnosis of intestinal tuberculosis. It has
been documented that barium studies are useful in 75% patients with suspected intestinal
tuberculosis.
 Computed Tomography (CT) : Abdominal CT scan is better than ultrasound for detecting high
density ascites, lymphadenopathy with caseation.
 MRI (Magnetic Resonance Imaging) MRI when compared to CT has no added advantage in the
diagnosis of abdominal tuberculosis, hence, its utility in abdominal tuberculosis is limited.
 Endoscopy: Endoscopy visualizes the tubercular lesion directly, hence, is a useful tool in the
diagnosis of colonic and gastro-duodenal tuberculosis; and helps in the confirmation of the diagnosis
by obtaining histopathological evidence of tuberculosis.
 Laparoscopy: Laparoscopy examination is an effective method of diagnosing tubercular peritonitis
because (i) it directly visualizes the inflamed thickened peritoneum studded with whitish-yellow
miliary tubercles and (ii) biopsy of the peritoneum confirms the diagnosis. • Laparoscopy facilitates
an accurate diagnosis in 80- 90% of patients
 Treatment
  Abdominal TB is generally responsive to medical treatment alone, so early diagnosis can prevent unnecessary surgical intervention
 The treatment of abdominal tuberculosis is on the same lines as for pulmonary tuberculosis.
 

Medical management
 Conventional antitubercular therapy for at least 6 months including initial 2 months of HREZ (e.g. isoniazid, rifampicin, ethambutol and
pyrazinamide) followed by 4 month HR is recommended in all patients with abdominal tuberculosis.
 Monitoring During Treatment of patients with tuberculosis requires careful monitoring for adverse effects since hepatotoxicity may be
caused by INH, RIF or PZA, patients receiving antituberculous therapy with first-line drugs should undergo baseline measurement of
hepatic enzymes (transaminases, bilirubin and alkaline phosphatase).

Surgical Treatment
 Surgery is usually reserved for patients who have developed complications, including free perforation, confined perforation with abscess or
fistula, massive bleeding, complete obstruction, or obstruction not responding to medical management.
 Surgical diagnostic methods are Laparoscopy Laparotomy Colonoscopy
 Nursing interventions

 Maintain body temperature and implement fever resolution measures

 Maintain optimal nutritional intake and improved nutritional status of the client.
 Provide adequate knowledge and information about importance of taking antituberculosis
mediations and its adverse side effects.