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. symptoms of obstruction: abdominal pain, anorexia, nausea and vomiting

Pathophysiology

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 Ghon focus or complex – this granulomatous reaction serves to prevent the spread of the infection

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

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

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

Differentials

Crohn’s Disease Rule InRule Out focal inflammation and fistula tract formation that eventually resolves by fibrosis and bowel stricturing  obstruction no reports of mucus, blood or pus in the patient’s stool; no fever or diarrhea presentation of Crohn’s Disease may mimic colonic tuberculosis and vice versa characteristic "cobblestone" appearance of CD was not exhibited on barium radiography patient is not dehydrated, but she shows signs of severe malnutrition: Malabsorption in Crohn’s more common in Europe, the United Kingdom, and North America. chronic history of recurrent episodes of abdominal pain patient does not fall within the usual age groups affected by the disease, which are those aged and those aged 60-80, since the age of onset has a bimodal distribution Patient shows signs of obstruction

Colon Cancer Rule InRule Out rate and severity of weight loss, as well as the evidence of muscle wasting are suggestive of malignancy rate at which the patient’s condition worsened may be too rapid to indicate a cancerous process Abdominal pain and intestinal obstruction are common clinical presentations Colorectal cancer usually develops in older patients aged around 65 patient does not present with rectal bleeding, changes in bowel habits, a palpable abdominal mass, hepatomegaly or ascites

Lipoma of the Distal Ileum Rule InRule Out common benign mesenchymal tumor, which frequently occurs in the distal ileum and at the ileocecal valve condition is usually asymptomatic, but may cause fecal bleeding, which is absent in the patient usually presents with generalized or colicky abdominal pain, vomiting, nausea and anorexia, which are all exhibited by the patient. intussusception is usually produced rather than a plain obstruction

Lymphoma of the distal ileum Rule InRule Out bloating, abdominal pain, weight loss, vomiting, and occasional intestinal obstruction. It can also show symptoms of malabsorption Although partial small-bowel obstruction is the most common mode of presentation, 10% of patients with small-intestinal lymphoma present with bowel perforation. Contrast radiographs show stasis of the contrast can also present with blood loss in vomitus or while defecating Primary intestinal lymphoma accounts for ~20% of malignancies of the small bowel history of malabsorptive conditions (e.g., celiac sprue), regional enteritis, and depressed immune function due to congenital immunodeficiency syndromes, prior organ transplantation, autoimmune disorders, or AIDS Periumbilical pain made worse by eating patient’s radiographs do not show infiltration and thickening of the mucosal folds, mucosal nodules, or areas of irregular ulceration