PERITONEAL (ABDOMINAL) TUBERCULOSIS
Abdominal tuberculosis (TB) includes involvement of the gastrointestinal tract, peritoneum, lymph nodes, and/or solid organs. Abdominal TB comprises around 5 percent of all cases of TB worldwide.
Issues related to TB involving the intestinal tract, peritoneum, and liver will be reviewed here; issues related to clinical manifestations, diagnosis, and treatment of pulmonary TB are discussed separately.
RISK FACTORS OF PERITONEAL TUBERCULOSIS: -
Risk factors for development of abdominal TB include cirrhosis, human immunodeficiency virus (HIV) infection, diabetes mellitus, underlying malignancy, malnutrition, treatment with antitumor necrosis factor agents, corticosteroids, and use of continuous ambulatory peritoneal dialysis. Issues related to the epidemiology of TB are discussed further separately.
FORMS OF DISEASE: -
Abdominal TB can present with involvement of any of the following sites: peritoneum, stomach, intestinal tract, hepatobiliary tree, pancreas, perianal area, and lymph nodes. The most common forms of disease include involvement of the peritoneum, intestine, and/or lymph nodes.
TB of the abdomen may occur via reactivation of latent TB infection or by ingestion of tuberculous mycobacteria (as with ingestion of unpasteurized milk or undercooked meat). In the setting of active pulmonary TB or miliary TB, abdominal involvement may develop via hematogenous spread via contiguous spread of TB from adjacent organs (such as retrograde spread from the fallopian tubes) or via spread through lymphatic channels.
Age group:- Abdominal TB is predominant in individuals <40 years of age, with greater frequency in females.
Clinical manifestations:- are nonspecific, frequently mimicking other abdominal diseases such as inflammatory intestinal disease, advanced ovarian cancer, deep mycosis, Yersinia infection and amebomas. The clinical presentation can be acute or chronically intermittent. Most patients (80–95%) have abdominal pain, 40–90% fever, 11–20% diarrhea and constipation, and 40–90% weight loss, anorexia and malaise. Patients with peritoneal TB manifest a slowly progressive abdominal swelling from ascites and abdominal pain. Adhesions may also cause small intestine obstruction. On physical examination, diffuse abdominal tenderness, doughy abdomen, hepatomegaly and ascites may also be present.
The risk factors for developing peritoneal TB are:- HIV infection, cirrhosis, diabetes, malignancy and receiving continuous ambulatory peritoneal dialysis.
TYPES OF PERITONEAL TUBERCULOSIS :-
Peritoneal TB occurs in three types:
(i) the wet type with ascites,
(ii) the encysted type with abdominal swelling, and
(iii) the fibrotic type with abdominal masses composed of mesenteric and omental thickening.
HOMOEOPATHIC MANAGEMENT OF PERITONEAL TUBERCULOSIS: -
Tuberculinum:- Some specific symptoms indicating the remedy are all gone sensations, hungry sensation, desire for milk, craving for meat but it disagrees. Early morning sudden diarrhoea. Stools are dark brown.
Pulsatilla:- In this medicine, the tongue is coated with thick white fur. There is thirstlessness and putrid taste of mouth in the morning. Craving for lemonade and aversion to fats is seen. Feeling of fullness one or two hours after the meals. There is also nausea and vomiting of undigested food.
Arsenicum album:- The patient is impatient. There is weakness and prostration. Restlessness and apprehension, midnight aggravation, along with burning pains.