gastric tuberculosis
Introduction
Introduction to stomach tuberculosis Stomach tuberculosis is the rarest form of tuberculosis infection in various organs of the human body. Benjamin (1933) can only collect 225 cases from the world literature, while Good has only 3 cases of stomach tuberculosis in 7 416 cases of stomach surgery, which shows that the disease is very Rarely, patients with advanced tuberculosis suffer from intestinal tuberculosis and there are so few people with stomach tuberculosis. The mechanism is unknown, or it is related to the bactericidal power of the stomach and the lack of lymphoid follicles in the stomach wall. basic knowledge The proportion of the disease: the incidence rate is about 0.01% - 0.02%, the incidence of tuberculosis patients with this disease is about 2-6% Susceptible people: no special people Mode of infection: contagious Complications: pyloric obstruction malnutrition stomach bleeding anemia
Cause
Stomach tuberculosis
Causes:
The vast majority of stomach tuberculosis is secondary, with more than half of the primary lesions being tuberculosis, and the rest being intestinal tuberculosis, bone tuberculosis and accessory tuberculosis. The path of infection into the stomach wall may be: 1 direct invasion of the mucosa; 2 transmission through the blood and lymphatic vessels; 3 direct spread from adjacent infiltration; 4 additional infection of tuberculosis in other lesions of the stomach wall such as benign ulcers or malignant tumors.
Pathogenesis:
1, the location of the disease
Stomach tuberculosis occurs mostly in the apical and anterior pyloric areas, and a small number occurs in the corpus or large curved side.
2, pathological type
(1) Ulcer type: This type is the most common, accounting for about 80%. The ulcer can be single or multiple, most of them are shallow and small, the edges are irregular, gray nodules can be seen at the base, and ulcers are large, deep muscle layer and The serosal layer forms a penetrating ulcer or fistula, but acute perforation is rare. A small number of patients can invade large blood vessels and cause massive hemorrhage. Ulcer scar formation can lead to pyloric obstruction.
(2) mass type: due to inflammatory hypertrophy or proliferative lesions to form a mass or large nodules, can also be formed by the adhesion of the stomach and surrounding organs to form a mass, pyloric lesions easily lead to obstruction.
(3) Miliary nodular type: It is part of the whole body miliary tuberculosis, and the layers of the stomach wall can be seen scattered in the miliary nodules.
(4) Inflammatory proliferative type (diffuse invasive type): The lesion often involves various layers of the stomach wall, so the stomach wall is thickened and the mucosa is polypoid-like hyperplasia.
3. Organizational form
The lymph nodes near the pathological lesions often have swelling and caseous necrosis. Pathological histological examination shows typical caseous granuloma, often located in the mucosa and submucosa, rarely involving the muscular layer, and acid-fast staining can be found in the tissue section.
Prevention
Stomach tuberculosis prevention
Mainly to actively prevent and treat primary tuberculosis. After entering the 1990s, tuberculosis, which has already been controlled, has become a widespread trend worldwide. People's struggle against tuberculosis has entered a new era. Tuberculosis bacteria with certain resistance are more difficult to treat, so it is very important to prevent tuberculosis. When you have low-grade fever, weight loss, fatigue, cough, night sweats, and other causes, you should go to the hospital for examination and diagnosis. Regular and full-time medication under the guidance of a specialist, the course of treatment should not be shorter than half a year. Patients should have sufficient patience, rest, adequate nutrition, proper outdoor activities, and enhance the body's resistance. It is still an important condition for overcoming the disease. Patients should be properly isolated during sterilizing, and it is important to protect the health of family members and groups, especially children.
Complication
Stomach tuberculosis complications Complications pyloric obstruction malnutrition stomach bleeding anemia
Stomach tuberculosis can cause bleeding, vomiting coffee, and can be accompanied by loss of appetite and weight loss. Stomach tuberculosis can cause pyloric obstruction, so there may be overnight food and sour liquid and mucus in vomit, but not mixed with bile, due to Malnutrition, stomach bleeding and other reasons, often manifested as anemia.
Symptom
Stomach tuberculosis symptoms Common symptoms Abdominal discomfort Night night sweats fatigue nausea Weight loss Abdominal pain Sputum bloating fever
The clinical manifestations of gastric tuberculosis are very inconsistent, some are asymptomatic or very mild, some are similar to chronic gastritis, gastric cancer, mostly ulcer disease, patients have upper abdominal discomfort or pain, often accompanied by acid reflux, abdominal pain and eating have nothing to do, pyloric obstruction The performance of vomiting is mostly in the afternoon, the night is heavy, the vomit is the food that enters, does not contain bile, the occult blood can be negative, the bloating is relieved after vomiting, in addition to the stomach symptoms can also be accompanied by systemic tuberculosis symptoms, such as fatigue, weight loss, Afternoon fever, night sweats, etc., physical examination of the upper abdomen can sometimes touch irregular masses, when there is pyloric obstruction, stomach shape in the upper abdomen, peristaltic waves and shock water.
There is no characteristic clinical manifestation of gastric tuberculosis, and there is no specific sign in X-ray and gastroscopy. Therefore, the clinical diagnosis is quite difficult. The cases reported in the early cases have been confirmed by surgery or autopsy. In recent years, the number of patients diagnosed by gastroscopy biopsy has gradually increased, thus avoiding some patients. surgery.
Examine
Stomach tuberculosis check
1, hematology examination
Often mild anemia, erythrocyte sedimentation rate can be increased, and tuberculosis antibodies can be detected in serum.
2, fecal occult blood test
Can be positive.
3, PPD skin test
Most positive or strongly positive.
4, gastric juice analysis
Often reduced, some patients have no stomach acid deficiency.
5, gastroscopy biopsy
The slices were positive for acid-fast staining and had a cheese-like granuloma.
6, X-ray barium meal inspection
There are no specific X-ray signs of gastric tuberculosis, which can be manifested as sputum, filling defect, sinus stenosis, often duodenal involvement and pyloric obstruction signs, gastric mucosa is rough, stomach wall is still soft, but there is also stomach wall stiffness. A few even in the leather stomach, these signs are indistinguishable from gastric ulcer, gastric cancer, gastric malignant lymphoma and gastric Crohn's disease. A group of 11 cases of gastric tuberculosis were reported to be misdiagnosed.
7, gastroscopy
For the main method of diagnosing tuberculosis, gastroscopic observation of gastric tuberculosis is still not easy to distinguish from gastric ulcer or gastric cancer, but biopsy found that the following conditions are helpful for the diagnosis of tuberculosis: (1) cheese-like granuloma; Tuberculosis is detected by biochemical staining or biopsy material culture; (3) polymerase chain reaction (PCR) detection, Mycobacterium tuberculosis DNA is positive, if the lesion is located in the muscular layer without destroying the mucosa, it is easily misdiagnosed as a smooth muscle tumor during gastroscopy. For submucosal lesions, such as biopsy, too shallow or negative.
Diagnosis
Diagnosis and identification of gastric tuberculosis
diagnosis
Histological and bacteriological examinations are currently considered to be the only confirmed method for tuberculosis.
Clinically, if gastric lesions occur in young people, it is not effective for regular anti-ulcer drug treatment, and stomach tuberculosis should be considered when the following conditions are involved: 1 There are other sites of tuberculosis; 2 PPD test is strongly positive without other organ tuberculosis 3 touch the abdominal mass; 4X line shows the fistula or sinus; 5 stomach and duodenum are affected at the same time and the lesion is continuous.
Differential diagnosis
Stomach tuberculosis should be differentiated from gastric ulcer, gastric malignant tumor, gastric Crohn's disease, etc., mainly based on histopathology and bacteriological examination. It should be noted that some stomach tuberculosis can coexist with gastric ulcer or gastric cancer. Highly suspected gastric tuberculosis can be carefully considered. Sexual anti-tuberculosis treatment, if effective to confirm the diagnosis, if the identification is still difficult and has surgical indications, surgical exploration can not only confirm the diagnosis, but also the treatment.
