mesenteric lymph node tuberculosis
Introduction
Introduction to mesenteric lymph node tuberculosis Mesenteric lymph node tuberculosis, also known as tuberculous mesenteric lymphadenitis (tuberculousmesentericlymphadenitis), is caused by Mycobacterium tuberculosis infection. Tuberculosis infection, which may be primary or secondary to other parts of the body, occurs mostly in children. Intermittent abdominal pain and diarrhea are the main manifestations, which can lead to malnutrition and intestinal adhesions. The system's anti-tuberculosis treatment has a good effect. basic knowledge The proportion of sickness: 0.01% Susceptible people: more than children Mode of infection: non-infectious Complications: tuberculosis, intestinal tuberculosis, peritonitis, pyloric obstruction
Cause
Mesenteric lymph node tuberculosis
(1) Causes of the disease
Mycobacterium tuberculosis infection can cause mesenteric lymph node tuberculosis. This disease is more common in children and adolescents. It is usually primary and secondary. The primary disease is often caused by drinking milk or dairy products contaminated with tubercle bacilli; secondary is more primary. More common, more secondary to open tuberculosis or intestinal tuberculosis, if the diseased lymph nodes rupture can cause tuberculous peritonitis.
(two) pathogenesis
The disease is more common in childhood, it can be primary, or it may be continued after intestinal tuberculosis or tuberculosis. In the original case, the bacteria mostly enter the lymph nodes directly through the healthy intestinal wall, or the intestines. The original lesions of the wall have completely healed without leaving traces. In the case of the case, most of the lesions in the lungs or intestines are obvious. The most affected lymph nodes are in the ileocecal area, in the retroperitoneal space on the inner side of the cecum and ascending colon. In the lower part of the small mesentery, occasionally, the lymph nodes of the upper abdomen may also have tuberculous lesions. Depending on the stage of the disease, the affected lymph nodes may have acute swelling, which is different from cheese, suppuration, or induration calcification. Changes, some calcified lymph nodes can be as hard as stones, and are very similar to kidney stones or gallstones on X-ray examination. They often need to be identified by pyelography or cholangiography. Some lymph nodes or cold abscess can be fused together. It is as big as a fist and must be opened for exploration.
Prevention
Mesenteric lymph node tuberculosis prevention
First, to control the source of infection, the main source of infection of tuberculosis is tuberculosis patients, TB positive patients receive early chemotherapy, sputum tuberculosis can be reduced in the short term, and even disappear, almost 100% can be cured, so early detection of patients, Especially the positive bacteria, and timely administration of reasonable chemotherapy is the central link of modern flood control work. The method of early detection of patients is to timely perform X-ray chest X-ray and bacteriological examination of suspected patients.
Second, cut off the route of infection, tuberculosis mainly through the respiratory tract infection, so it is forbidden to spit, the cockroaches, daily necessities, and surrounding things of the bacteria-positive patients should be disinfected and properly treated, indoors can be disinfected by ultraviolet radiation, patients used food It can be boiled, and it is exposed to the sun under the sun. The toilet can be soaked with 5%-10% to the Soviet Union; it should be kept indoors, air clean, bathing, and changing clothes.
Third, protect susceptible populations.
Inoculated with BCG, it is a non-virulent live vaccine. After inoculation in human body, it can obtain specific immunity against tuberculosis in people who are not infected with tuberculosis. The protection rate is about 80% and can be maintained for 5-10 years. The main inoculation targets are newborns and infants, large and middle school students and new ethnic minority areas who enter the city. However, the immunity generated by vaccination with BCG is relatively high, and other preventive measures should be emphasized.
Complication
Mesenteric lymph node tuberculosis complications Complications, tuberculosis, intestinal tuberculosis, peritonitis, pyloric obstruction
Often complicated by open tuberculosis or intestinal tuberculosis, tuberculous peritonitis, ascites and abdominal varices, pyloric obstruction, incomplete intestinal obstruction and other diseases.
Symptom
Mesenteric lymph node tuberculosis symptoms Common symptoms Abdominal mass nausea lymph node tuberculosis fatigue tuberculosis poisoning loss of appetite constipation with abdominal mass block abdominal pain low heat night sweats
Clinically, acute mesenteric lymph node tuberculosis can be suspected of acute appendicitis, acute gastroenteritis and the like.
Acute mesenteric lymphadenitis
(1) Symptoms: When the patient is tired and uncomfortable, there is intermittent abdominal pain in the umbilicus or right lower quadrant. The pain may be accompanied by nausea and vomiting. After 1 to 2 days, the pain is relieved, but in the future, the attack may be intensified, and the fever may continue, often diarrhea. Watery stools and black stinky stools are also common symptoms.
(2) signs: abdominal fullness and tenderness, tenderness is most prominent in the right lower quadrant, sometimes a small amount of lumps can be touched, which is easily confused with acute appendicitis.
2. Chronic mesenteric lymphadenopathy
(1) Symptoms: diarrhea and fatty diarrhea, patients with chronic diarrhea and lymph node enlargement, often have malnutrition, such as weight loss, anemia and fatigue, such as those with peritoneal tuberculosis, the symptoms will be exacerbated, patients often There is a moderate heat type, loss of appetite, significant weight loss, and mental fatigue.
(2) Signs: abdominal distension, chronic tenderness.
Examine
Examination of mesenteric lymph node tuberculosis
1. Erythrocyte sedimentation rate: more obvious acceleration, can be used as one of the indicators to assess the extent of tuberculosis activity.
2. Blood routine
(1) The white blood cell count is normal and the lymphocytes are increased.
(2) Hemoglobin is slightly reduced.
3. Plasma protein: Nearly 20% of chronic patients have hypoproteinemia.
4. Tuberculin test: tuberculin 1:10000 test was positive, with reference value.
5.X line
(1) Abdominal plain film: There is a shadow of scattered calcification outside the mesentery, especially at the end of the ileum.
(2) barium meal angiography: If combined with intestinal tuberculosis, the bowel movement is too fast, the lesion segment is stimulated and contracted, the filling is not good, when the lesion invades the small intestine, the barium meal can be stimulated, the small intestine is strengthened, and the stenosis occurs.
(3) Chest X-ray: Tuberculosis lesions in the lungs can be found.
Diagnosis
Diagnosis and diagnosis of mesenteric lymph node tuberculosis
1. Medical history: history of eating unsterilized milk, history of tuberculosis exposure or history of tuberculosis.
2. Clinical features
(1) Digestive tract symptoms and signs: abdominal pain, diarrhea or constipation, abdominal mass.
(2) Symptoms of tuberculosis poisoning: fever, night sweats, loss of appetite, weight loss, etc.
(3) Anti-tuberculosis treatment is effective.
3. The tuberculin test is strongly positive or other immunological tests are positive.
4. X-ray examination: the mesentery has a caseous necrotic lesion.
Should be differentiated from chronic appendicitis, ileocecal malignant lymph node, intussusception, if the X-ray examination is similar to the shadow of the stone, it is still necessary to distinguish with kidney stones or gallstones by pyelography or cholangiography.
