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Primary Impression

Primary Impression. Active Pulmonary TB and Gastrointestinal tuberculosis. previous history of TB No sputum AFB smear was done to see if the patient has really been cured Possibility of relapse current symptoms and x-ray results Fever, weight loss, etc.

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Primary Impression

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  1. Primary Impression

  2. Active Pulmonary TB and Gastrointestinal tuberculosis • previous history of TB • No sputum AFB smear was done to see if the patient has really been cured • Possibility of relapse • current symptoms and x-ray results • Fever, weight loss, etc. • symptoms of obstruction:abdominal pain, anorexia, nausea and vomiting

  3. Pathophysiology

  4. Primary Infection Inhalation of droplet Mycobacterium tuberculosis Invasion of alveoli by bacteria, macrophages react Formation of Ghon (Primary) complex Granulomatous reaction to prevent spread of infection

  5. Active Pulmonary TB Patient becomes immunocompromised Reactivation of primary infection Destruction and caseous necrosis of lung tissue Scarring and cavitation

  6. From the lungs to the GI system… Ingestion of infected sputum OBSTRUCTION Hematogenously: via lymph nodes (LN) Inflammation and fibrosis of bowel walls and regional LN Fibrosis and thickening of bowel wall Local spread of infection Necrosis of Peyer’s patches and lymph follicles Ulceration of mucosa

  7. Active Pulmonary TB and Gastrointestinal tuberculosis • Mycobacterium tuberculosis • Transmission: infected air droplets • Primary infection: usually asymptomatic and latent. • bacteria reach the pulmonary alveoli and invade the macrophages • Formation of Ghonfocus or complex • this granulomatous reaction serves to prevent the spread of the infection

  8. Active Pulmonary TB and Gastrointestinal tuberculosis • Patient becomes immunocompromisedreactivation • Caseous necrosis • destruction and necrosis of the lung tissue • Scarring, cavitation

  9. Active Pulmonary TB and Gastrointestinal tuberculosis • Infection from the lungsgastrointestinal tract • ingestion of infected sputum by patients with active TB • Hematogenously: lymph nodes • Local spread of infection

  10. Active Pulmonary TB and Gastrointestinal tuberculosis • In the GIT: • bowel walls and regional lymph nodes: inflammation and fibrosis. • necrosis of the Peyer’s patches and the lymph follicles ulceration of mucosa  fibrosis  thickening of bowel wall  mass lesions • Symptoms of obstruction

  11. Differentials

  12. Crohn’s Disease

  13. Colon Cancer

  14. Lipoma of the Distal Ileum

  15. Lymphoma of the distal ileum

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