TB affecting the Intestine

Question 1

What is intestinal TB?

Answer 1

Reactivation of primary disease by mycobacterium TB

Question 2

Who gets it?

Answer 2

-Ethnic minorities & immunocompromised

Question 3

How does intestinal TB present?

Answer 3

-Abdo pain
-Wt loss
-Anaemia
-Fever with night sweats
-Obstruction
-RIF pain
-Palpable mass
-Ileocaecal area most commonly affected
1/3 present with Intestinal obstruction or generalized peritonitis

Question 4

What do 1/3 of TB affecting intestinal cases present with?

Answer 4

Intestinal obstruction

Generalized peritonitis

Question 5

How is intestinal TB diagnosed?

Answer 5

Small bowel follow through
US, MRI or CT
Histology

Question 6

What can a small bowel follow through show?

Answer 6

Transverse ulceration

Diffuse narrowing of the bowel with caecal pole shortening

Question 7

What will MRI/CT or US show?

Answer 7

Any additional thickening of mesentery and lymph node enlargement

Question 8

Histology of TB intestinal?

Answer 8

Chronic inflammation with caseating granuloma, acid fast bacilli may be seen

Question 9

DDs for intestinal TB?

Answer 9

Crohn’s

Caecal Carcinoma

Question 10

Treatment for intestinal TB?

Answer 10

Similar to lung treatment = 12 months with:

• 2 months isoniazid, rifampicin, pyrazinamide & etambutol
• 10 months isoniazid & rifampicin

Question 11

Initial drugs for TB treatment? (x4)

Answer 11

Isoniazid
Rifampicin
Pyrazinamide
Etambutol