Tuberculous Peritonitis causes , clinical picture , investigations and treatment

This is a brief review of Tuberculous Peritonitis , which is a serious medical case that results in many serious complications .
Here , we will discuss the Aetiology , Pathology , Diagnosis and management of the disease , so let's start .

Etiology

- Age: usually 5-20 years. 
- Sex: equal.
- Mode of infection:

-- Secondary to: Tuberculous mesenteric LNs, tuberculous ente . tuberculosis of fallopian tubes or pulmonary tuberculosis.

-- Primary (Rare): Occurs in children taking infected milk.


Pathology

• One of three types may occur:

1. Ascitic type: Free fluid in the peritoneum.

2. Loculated type: Adhesions create many loculi, each containing ascitic fluid.

3. Adhesive form:  Marked adhesions between the intestinal loops.

• Tuberculous infection of mesenteric lymph nodes (tabes mesenterica).

• The omentum may form a rolled mass due to adhesions.

Complications

1. Intestinal obstruction. due to adhesions.
2. Fistula formation.

Clinical Picture
- Features of toxaemia: loss of weight & appetite, fever & sweating.

- Disturbed bowel habits: Constipation or diarrhoea.

- Abdominal discomfort or pain.

- Abdominal examination may show:

1. Generalised tenderness with mild rigidity (doughy sensation).

2. Free or encysted ascites, usually of small volume.

3. Palpable masses, rolled omentum or distended intestinal loops.

4. Visible peristalsis in cases of acute intestinal obstruction.

5. No palpable liver or spleen .

Investigations

1. Ultrasonography: may show
• Free or encysted ascites.
• Lymph nodes.
• No affection of the liver & spleen.

2. The ascitic fluid:

• Yelloish & may be turbid.
• High specific gravity: more than 1015.
• Rich in proteins & lymphocytes.
• Tubercle bacilli are detected by culture or PCR

 3. Laparoscopy:

• Show peritoneal nodules & biopsy will show the pathology.

Treatment

1. Rest, nutritive diet & vitamins.
2. Anti-tuberculous treatment.

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