Constipation with abdominal mass
Introduction
Introduction Constipation with abdominal mass may be colon tumor, intra-abdominal tumor compression colon, intestinal tuberculosis, Crohn's disease (Crohn's disease) or enlarged lymph nodes. Constipation with abdominal mass is one of the common symptoms of intestinal tuberculosis. Intestinal tuberculosis is the most common tuberculosis in the digestive system. The vast majority are secondary to extraintestinal tuberculosis, especially hollow tuberculosis. According to statistics, 25% to 50% of tuberculosis patients can be complicated by intestinal tuberculosis. The source of intestinal tuberculosis is mainly ingestive, caused by swallowing sputum containing tubercle bacilli, occasionally from food contaminated by tuberculosis, or directly from blood-borne or abdominal, pelvic other organs spread. The age of onset is mostly young and middle-aged, with more women than men, about 1.85:1. Pathologically divided into ulcer type, proliferative type and mixed type.
Cause
Cause
(1) Causes of intestinal tuberculosis
More than 90% of intestinal tuberculosis is caused by human tuberculosis. In addition, drinking dairy products that have not been strictly disinfected can cause disease due to bovine tuberculosis. Intestinal tuberculosis infection can be caused by oral, hematogenous spread and tuberculosis of adjacent organs. . The onset of tuberculosis is the result of the interaction between human body and tuberculosis. The infection obtained by the above-mentioned route is only a disease-causing condition. Only when the number of invasive tuberculosis bacteria is large, the virulence is large, and the human immune function is abnormal, and intestinal dysfunction It will only occur when the local resistance is weakened.
(B) the pathogenesis of intestinal tuberculosis
More than 90% of intestinal tuberculosis is caused by human MTB, and a few can be caused by bovine type MTB. The pathways by which MTB causes intestinal infection are mainly intestinal, blood-borne and direct spread.
1. Intestinal: MTB is mainly invaded into the intestine by oral infection. The patient is often open tuberculosis, which is caused by swallowing sputum containing MTB. Or often eat with open tuberculosis patients, lack of necessary disinfection and isolation measures to cause disease. In rare cases, unsterilized milk or dairy products containing MTB can also cause primary intestinal tuberculosis. After the MTB enters the intestine, it causes lesions in the ileocecal area because:
1 Under normal physiological conditions, the intestinal contents stay longer at the end of the ileum before passing through the ileocecal sphincter. In addition, the proximal end of the colon often has anti-creeping, which makes the intestinal contents stay longer in the cecum. Thus, MTB has a greater chance of contact with the intestinal mucosa, increasing the chance of infection of the intestinal mucosa.
2 The back of the ankle is rich in lymphoid tissue, and the MTB is easy to invade lymphoid tissue.
2. Blood-derived: When miliary tuberculosis occurs, MTB can be transmitted by blood to cause intestinal tuberculosis.
3. Direct spread: intra-abdominal tuberculosis lesions, such as female genital tuberculosis and direct spread of kidney tuberculosis can cause intestinal tuberculosis.
However, the above pathway to obtain infection is only a pathogenic condition. Only when the number of invading MTBs is large, the virulence is strong, and the human immune function is reduced, the intestinal dysfunction, and the local resistance are reduced.
Examine
an examination
Related inspection
Ultrasound examination of gastrointestinal diseases CT examination of gastrointestinal tract
Confirmation of intestinal tuberculosis should confirm the presence of Mycobacterium tuberculosis in intestinal mucosa. Intestinal tuberculosis should be considered if the following conditions exist.
1. Young and middle-aged patients have extraintestinal tuberculosis, especially in patients with open tuberculosis, or the systemic manifestations of tuberculosis after the original lesion has improved.
2. Clinical manifestations include diarrhea, abdominal pain, tenderness in the right lower quadrant, abdominal block, unexplained intestinal obstruction, accompanied by fever, night sweats and other symptoms of tuberculosis.
3. X-ray barium meal examination found signs of irritability, intestinal stenosis, and shortened deformation of the intestine.
4. The tuberculin test is strongly positive. For cases with high suspicion of intestinal tuberculosis, such as anti-tuberculosis treatment for 2 to 6 weeks, a clinical diagnosis of intestinal tuberculosis can be made. If the lesion is in the terminal ileum and colon, colonoscopy and biopsy can help diagnose and differential diagnosis. For those who have difficulty in diagnosis, mainly proliferative intestinal tuberculosis, sometimes need laparotomy to confirm the diagnosis.
Diagnosis
Differential diagnosis
1, constipation with severe abdominal pain: constipation with severe abdominal pain, bloating and vomiting and other symptoms, often prompted for acute constipation.
2, acute constipation: caused by intestinal obstruction, intestinal paralysis, acute peritonitis, cerebrovascular accident, acute myocardial infarction, perianal pain and other acute diseases, mainly manifested in the clinical manifestations of the primary disease.
3, chronic constipation: the reasons are more complicated, there are no obvious symptoms, but nervous allergies can complain of loss of appetite, mouth pain, bloating, belching, episodes of lower abdominal pain, excessive gastrointestinal symptoms, but also accompanied by dizziness, Symptoms of neurosis such as headache and fatigue. Symptoms may be related to dysmotility of the bowel movements and may also be related to mental factors. Because the feces are dry and hard, or in the form of sheep feces, the patient may have discomfort such as lower abdominal pain, falling feeling, etc. during defecation. Sometimes the left lower abdomen can touch the sigmoid colon of the sausage-like sputum.
4, frequent vomiting and constipation: is a common symptom of abdominal hernia. The intra-abdominal organ is called the intra-abdominal hernia from its original position, through a normal or abnormal channel or fissure in the abdominal cavity to an abnormal sulcus.
5, diarrhea and constipation alternate: diarrhea commonly known as "diarrhea", is one of the common symptoms of the digestive tract that everyone is familiar with. Constipation is just the opposite. The stool is not dry enough, and every time the stool is very laborious. The alternating diarrhea and constipation refers to a period of time, not constipation or diarrhea, which alternates. Sometimes constipation for several days, then suddenly diarrhea. If there is an exchange of diarrhea and constipation, you should be alert to colitis.
