双语肠结核与结核性腹膜炎英文教学课件.ppt

* * 复习思考题 1、试述肠结核的临床表现及诊断依据。 2、结核性腹膜炎的诊断要点有哪些？ 3、结核性腹膜炎的腹水实验室检查有何特点？ 4、患者出现右下腹包块伴排便习惯改变应考虑哪些疾病？ * * Thank you * * Intestinal Tuberculosis and Tuberculous Peritonitis * * Section I Intestinal Tuberculosis * * Intestinal tuberculosis(肠结核) is a specific chronic intestinal infection caused by mycobacterium tuberculosis(结核分枝杆菌). Definition Epidemiology Most patients are young female is more than male * * Mycobacterium tuberculosis Etiology * * 1.Oral infection ★pulmonary tuberculosis or laryngeal（喉） tuberculosis ★drinking un-pasteurized milk ★eating with patients 2. Hematogenous disseminated: miliary （粟粒性） tuberculosis 3.Direct spread of intra-abdominal tuberculosis Pathogenesis * * Predilection site ：ileocecal(回盲部) , ascending colon, jejunum(空肠), transverse colon, descending colon, appendix, duodenum and sigmoid colon. Pathological type Ulcer type Proliferative (增生) Mixed Pathology * * Ulcer type Mycobacteriumtuberculosis ulcer lymphatic groups, local hyperemia, edema, inflammatory exudate Caseous necrosis * * Proliferative Tuberculous granuloma and fibrous tissue proliferation Hardening or thickening of bowel wall intestinal stenosis, obstruction Mixed * * Abdominal pain: right lower quadrant, relieve after defecation Diarrhea and constipation : ulcer- diarrhea, fecal paste. proliferative- constipation Abdominal mass :proliferative Other symptoms ：TB toxemia, tuberculosis parenteral performance Clinical manifestations * * Complications Intestinal obstruction Fistula, abdominal abscess Intestinal perforation, intestinal bleeding * * ESR ↑, Hb↓ , PPD (tuberculin skin test) positive or strongly positive , T-spot Laboratory and other tests X-ray barium meal or barium enema examination Stierlin sign Mucosa coarse, the mural margin just looks like sawtooth, colon narrow . * * * * Muco