西安交通大学医学院消化系统疾病课件 Tuberculous Peritonitis.pptVIP

Tuberculous  Peritonitis Introduction Tuberculous peritonitis is a chronic, diffuse peritoneal infection caused by mycobacterium tuberculosis. It’s incidence has been declining for decades, but it is still a common disease. It’s insidious nature and the clinical circumstances in which it occurs often cause it to be mistake for neoplastic disease or cirrhosis. People below the age 40 are more likely to develop this disease.   Incidence of females are more likely than males with an ratio of 1.8 to 1. Etiology Most cases of tuberculous peritonitis are due to the tuberculous focus in body diffuse to peritoneum. Most are secondary to pulmonary tuberculosis and tuberculosis in the other part of body, about 5/6 patients have primary tuberculosis of lung or the other organ. Pathogenesis There are two routes of infection. One is the tuberculosis in the peritoneal cavity directly extension to peritoneum, such as lymph tuberculosis of mesentory, tuberculosis of intestines, tuberculosis of oviduct, they are the common directly primary focus.  Another way is hematogenous spread and is very little, often companied with tuberculous polyserositis, miliary tuberculosis, tuberculous meningitis or active tuberculosis of joint, bone, etc. Pathology Exudation type 1.Hyperemia, edema and exudation (ascites) occur on the peritoneum. 2.The peritoneum is covered by exudation of fiber and protein and innumerable military tubercles and lead to peritoneum become thick. 3. Yellow, or rarely bloody fluid exists in the peritoneal cavity. Adhension type 1.This type is characterized by fibrous regeneration leading to thickening of the peritoneum and adhension of the abdominal organs to form large mass. 2. Intestinal obstruction or obliteration of the abdominal cavity may occur. Caseation type 1.Caseous substance in the abdominal cavity is loculated into many small