GU TB Flashcards
primary vs post primary tb
where in body
primary granulomatous lesion in midder to upper zone of lung
spread to bacilli to GU tract via blood stream
immunity develops then infection becomes quiescent
post primary
reactivation primary infection triggered by immune compromise
histology of primary TB infection
central area of caeseating necrosis surrounded by epitheliod and langhans giant cells
this is called caveating granuloma
comprised of Langerhans giant cells surrounded by lymphocytes and fibroblasts and the healing of these lesions causes fibrosis and calcification
kidney changes in TB
caseous necrosis renal papillae -release bacilli into urine
granuloma formation
deformity calyces
fibrosis and calcification or auto nephrectomy due to fibrotic and shrunken irregular kidney due to healing fibrosis
ureter changes TB
stricture
ureteritis cystic
VUR
bladder changes TB
3
yellow lesions with red halo
thimble bladder
cystoscopy areas of bullous oedema
ulceration and haemorrhage
bladder changes TB
yellow lesions with red halo
thimble bladder
epididymis
epididymisis beaded cord, abscess infertility
investigation TB
urine pcr for tb EMU culture x 3 Ziehl Neelson staining to identify acid fast bacilli which will stain pink cultured on lowenstein jensen medium takes 6-8 weeks urine cytology cxr and sputum culture renal tract imaging cystoscopy
treatment TB
2 months of RIPE rifampicin izoniazid pyrazinamide ethambutol 4 months of RI
lifetime risk TB reactivation
10%
method of spread from lungs to GU
method spread from kidneys to bladder
haematogenous
then direct extension to pass to ureters and bladder
history in Tb
ehtnic background
foreign travel
crowded accomodation
symptoms lethargy, weight loss, night sweats, fevers, haemoptysis
uti no responding to treatment
other comorbidities, HIV, DM, steroid use
examination
chest and abdominal
any palpable LN
genital examination
urine dipstick sterile pyuria, no nitrites
CXR may show granuloma, sputum culture send
urine cytology exclude other causes sterile pyuria
tuberculin skin test
intra dermal injection of protein derivative of mTB
positive result suggests exposure to TB, no necessarily active infection. negative test excludes diagnosis of TB
why can’t gram stain TB
due to high lipid content of cell wall
