复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）消化系统_肠结核及结核性腹膜炎 Intestinal tuberculosis and tuberculous peritonitis

i Intestinal tuberculosis and tuberculous peritonitis GAO Hong Department of Gastroenterology, Zhongshan Hospital Fudan University Fudan University ZhongshanHlespitam

Fudan University Zhongshan Hospital www.themegallery.com GAO Hong Department of Gastroenterology, Zhongshan Hospital Fudan University Intestinal tuberculosis and tuberculous peritonitis

Objectives 1. To master the clinical manifestations, complications. diagnosis and differential agnosIs. 2. To master the diagnosis and differential diagnosis of ascites, especially saag and ADA: 3. To be familiar with the pathogenesis, classification, prevalence and the therapy of the diseases Fudan University ZhongshanHlespitam

Fudan University Zhongshan Hospital www.themegallery.com Objectives 1. To master the clinical manifestations, complications, diagnosis and differential diagnosis. 2. To master the diagnosis and differential diagnosis of ascites, especially SAAG and ADA; 3. To be familiar with the pathogenesis, classification, prevalence and the therapy of the diseases

Pathogen Mycobacterium tuberculosis is the pathogen in most cases Mycobacterium bovis in some parts of the world with no pasteurization of milk Mycobacterium avium intracellulare has become a major pathogen in HIV patients M. africanum. M. microti, and M. canetti 74 oxp e

Fudan University Zhongshan Hospital www.themegallery.com Pathogen • Mycobacterium tuberculosis is the pathogen in most cases. • Mycobacterium bovis in some parts of the world with no pasteurization of milk. • Mycobacterium avium intracellulare has become a major pathogen in HIV patients. • M. africanum, M. microti, and M. canetti

Estimated TB incidence rates, by country, 2009 25-49 5099 100-299 No estimate The boundaries and names shown and the designations used on this map do not imply Source: Global Tuberculosis the expression of any opinion whatsoever on the part of the World Health Organization Control 2010. WHO, 2010 World Health concerning the legal status of any country, territory, city or area or of its authorities, Organization or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement O WHO 2010. All rights reserved

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Epidemiology Second infectious disease in China aT-t. The epidemic is being accelerated by Co- infection with hiv and compounded by multi- drug resistant TB; The incidence of g tb is un known 20% pulmonary TB cases have extra pulmonary TB including GI TB 15-20%Gl TB case have pulmonary TB Fudan University ZhongshanHlespitam

Fudan University Zhongshan Hospital www.themegallery.com Epidemiology • Second infectious disease in China • The epidemic is being accelerated by co￾infection with HIV and compounded by multi￾drug resistant TB; • The incidence of GI TB is unknown; • 20% pulmonary TB cases have extra￾pulmonary TB including GI TB; • 15-20% GI TB case have pulmonary TB

Estimated Hiv prevalence in new TB cases, 2009 你 HIV prevalence n new TB cases 0-4 No estimate The boundaries and names shown and the designations used on this map do not imply Source the expression of any opinion whatsoever on the part of the World Health Organization Control 201 World Health concerning the legal status of any country, territory city or area or of its authorities, Organization r concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement O WHO 2010. All rights reserved

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Following infection, the incubation period of tb range from a few weeks to a lifetime Comstock et al. american journal of Epidemiology 99: 131-138 Fudan University ZhongshanHlespitam

Fudan University Zhongshan Hospital www.themegallery.com • Following infection, the incubation period of TB range from a few weeks to a lifetime. Comstock et al. American Journal of Epidemiology 99:131-138

B infection TB infection B infection and o risk factors and diabetes and HIv infection(a very (about 10% over a lifetime)(about 30% over a lifetime) high risk over a lifetime) For people with TB infection For people with TB infection For people with TB infection and no risk factors the risk is and diabetes the risk is 3 and HIv infection the risk is about 5% in the first 2 years times as high or about 30% about 7% to 10% PER YEAR fter infection and about 10% over a lifetime a very high risk over a over a lifetime lifetime Figure 1.6 Risk of developing TB disease over a lifetime Fudan University ZhongshanHlespitam

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Intestinal Tuberculosis Fudan University ZhongshanHlespitam

Fudan University Zhongshan Hospital www.themegallery.com Intestinal Tuberculosis

Infective route Ingestion of infected food or milk Swallowing of infected sputum from active lung disease Hematogenous spread from active pulmonary tB Direct spread from adjacent viscera Fudan University ZhongshanHlespitam

Fudan University Zhongshan Hospital www.themegallery.com Infective Route • Ingestion of infected food or milk • Swallowing of infected sputum from active lung disease • Hematogenous spread from active pulmonary TB • Direct spread from adjacent viscera