Intestinal tuberculosis symptoms, first signs

Causes

It is necessary to understand that tuberculosis always occurs due to mycobacteria entering the body. There are no other causes of intestinal tuberculosis. This pathogen has special properties that allow it to survive and adapt to the conditions of our body.

The group of Mycobacterium tuberculosis includes several types of pathogens, but not all are capable of causing disease in humans.

Properties of the bacterium:

• They have the shape of an extremely small stick.
• Capable of numerous mutations of the genetic apparatus.
• They can survive in an acidic environment, passing from the stomach to the intestines.
• In unfavorable conditions they are able to form special stable forms.
• The sticks are unable to move independently.
• Cells multiply quite quickly.
• They are able to survive inside human immune cells, so tuberculosis cannot be cured on its own.

The properties of mycobacteria are being actively studied by doctors and scientists to develop effective methods of treatment and prevention.

Causes of intestinal tuberculosis

In most situations, small intestinal tuberculosis is a secondary pathological process that occurs as the pulmonary form of tuberculosis infection progresses. Only in the case of alimentary infection with Mycobacterium tuberculosis is primary intestinal damage observed.

Gastric juice creates barrier conditions for tuberculosis infection, therefore, even if a large mass of virulent bacteria is systematically ingested, which occurs in the pulmonary form of tuberculosis, it does not provoke the development of secondary intestinal damage in all situations.

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Intestinal tuberculosis in children develops through nutritional means, that is, through the consumption of infected mother's milk while breastfeeding.

Primary pathological changes in intestinal tuberculosis occur in the regional mesenteric lymph nodes, the manifestation of which are signs of tuberculous mesadenitis.

Tuberculosis of the large intestine is pathomorphologically manifested by specific infiltrative and ulcerative tumor-like formations, as well as multiple dense nodules of small size and red color. Tuberculous granulomas are prone to secondary bacterial infection and the formation of pus. When the abscesses are opened, bleeding, confluent ulcers form.

With massive damage to the small and large intestines, conditions are created for perforation of the intestinal wall and the development of limited or diffuse peritonitis. In addition, a common clinical form of intestinal tuberculosis is anorectal, manifested by the formation of perirectal abscesses and chronic ulcers, the healing of which provokes the development of gross cicatricial changes and the formation of a narrowing of the rectum. The opening of a tuberculous pararectal abscess is manifested by the clinic of paraproctitis.

Development mechanism

The mechanism of pulmonary localization of tuberculosis has been known for a long time. Bacteria easily penetrate lung tissue through airborne transmission.

But how does a microorganism end up in intestinal tissues? There are several possible options for infection with a disease such as intestinal tuberculosis:

1. If the primary focus is in the lungs, then with a decrease in immunity, bacteria begin to penetrate into the blood. Through the vascular bed, the causative agent of tuberculosis ends up in various organs, where it can cause disease.
2. Less commonly, the pathogen spreads through the lymph from numerous intra-abdominal lymph nodes.
3. Much less often, isolated damage to the intestines alone is observed. It is assumed that bacteria enter through the nutritional route - through food and water.
4. Another option for intestinal tuberculosis infection is ingestion of sputum containing mycobacteria.

Risk factors for the disease are inflammatory bowel diseases, pathology of intestinal wall enzymes, chronic pancreatitis, and oncological processes.

These conditions disrupt local immunity in the organ, as a result of which infection quickly develops.

Symptoms

It is very difficult to make a diagnosis of intestinal tuberculosis if the pulmonary form of the disease has not previously been detected in this patient. This is due to the fact that for a very long time the disease does not have specific manifestations.

Possible symptoms of intestinal tuberculosis:

• General weakness, intoxication.
• Possible increase in body temperature.
• Weight loss of several kilograms in 6 months.
• Abdominal pain occurs quite often. Distributed throughout the abdomen.
• Over time, the pain is concentrated in the right lower abdomen.
• Nausea and vomiting - during exacerbation of the disease.
• Often constipation, less often diarrhea.
• Frequent and false urge to defecate is possible.

Upon palpation, the doctor can detect an enlarged and swollen intestine in various parts. The presence of a tuberculous ulcer can cause anemic syndrome.

Symptoms that appear with intestinal tuberculosis

The clinical picture of intestinal tuberculosis can easily be confused with other diseases. Such features make diagnosing the disease more difficult and time-consuming. Also, the initial stage of development of the disease does not cause particularly noticeable symptoms, so the pathology is often discovered in an advanced form.

Having begun to poison the body, tuberculosis becomes more noticeable.

It can be noticed by the following manifestations:

• pain in the abdomen, and over time the source of pain moves to the right side between the pelvis and lower ribs;
• the patient often begins to feel sick, and as the disease progresses, strong vomiting appears;
• the functioning of the intestines becomes not as smooth as before, and therefore the patient experiences frequent constipation or diarrhea;
• an aggravated form of the pathology is characterized by bloating, spasticity of the ileal loop, as well as excessive softness and soreness of the peritoneum.

In most cases, the disease interferes with the ileocecal valve, which separates the small and large intestines. Such lesions cause stomach problems and digestive disorders.

Signs of these violations are:

• loss of appetite;
• heaviness in the stomach after eating;
• lethargy and loss of human activity;
• poor general health;
• causeless sweating in large quantities;
• constant urge to excrete feces, which ultimately does not end with defecation;
• Very painful formations appear on the walls of the intestine, which can be felt during examination by palpation.

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In the asymptomatic form of the disease, intestinal tuberculosis proceeds unnoticed. A completely natural situation would be the first manifestation of pathology only ten years after infection.

Complications

The disease is a chronic infection. Intestinal tuberculosis flows slowly and for a long time, gradually affecting various parts of the organ.

The most dangerous point is the risk of developing complications of the disease that require emergency care:

1. A tuberculous ulcer can lead to significant blood loss. A sharp pain occurs in the abdomen, the stool becomes dark in color. Symptoms of anemia occur. Sometimes it requires surgical treatment.
2. A prolonged inflammatory process, the presence of tuberculous granulomas and ulcers lead to a gradual decrease in the lumen of the intestinal tube. This may be a predisposing factor for the development of acute intestinal obstruction. This condition also requires surgical intervention.
3. Perforation of an ulcer into the abdominal cavity causes bleeding and peritonitis. The latter condition is life-threatening and leads to disruption of mineral metabolism and severe intoxication.

You can prevent the occurrence of complications if you start tuberculosis treatment on time and pay attention to the first symptoms of the disease.

Diagnostics

If intestinal tuberculosis is suspected, the attending physician must conduct a series of examinations and refer the patient for consultation with a phthisiatrician. This specialist will conduct further diagnosis and treatment of the patient.

Diagnostic signs of intestinal tuberculosis can be:

• Positive skin tests for tuberculosis.
• Presence of pulmonary tuberculosis on the radiograph.
• Anemia and increased erythrocyte sedimentation rate in a general blood test.
• Detection of tuberculosis microbacteria in stool and blood. Mucus and leukocytes in the stool are only a sign of an inflammatory process of any nature.
• X-ray of the abdominal organs with contrast allows you to notice the presence of ulcers, dilations and narrowings of the intestinal tube, defects in contrast filling, and areas of obstruction.
• Colonoscopy involves inserting a device with a camera into the anus and examining the contents of the intestines directly through the doctor's eye. Allows you to take a biopsy of a suspicious area of ​​the organ and study it in the laboratory.
• If localized in the duodenum, fibrogastroduodenoscopy with biopsy is performed.

Histological examination of intestinal biopsies allows one to definitively confirm the diagnosis of tuberculosis.

Diagnosis of intestinal tuberculosis

To diagnose intestinal tuberculosis, a comprehensive examination is necessary, including an x-ray of the chest and abdomen, irrigoscopy, x-ray of the small intestine, laparoscopy, tuberculin tests and colonoscopy (a stool test for blood content is also allowed). Together with ultrasound, all the methods described above can reveal the following structural changes:

• filling defect;
• absent haustration (a set of folds of the colon);
• narrowing and shortening of the damaged sector of the intestine;
• abnormal barium retention in the cecum;
• enlarged lymph nodes in the corresponding area.

Types and classification of intestinal infections

In turn, if the rectum has been exposed to infection, this can be revealed during a proctological examination, finding festering ulcers there with a raised rim and a smooth bottom. Again, the diameter of the intestine in this place is most often narrowed, and treatment of such paraproctitis takes a long time (with chronic heavy discharge and no pain).

One way or another, intestinal tuberculosis can be reliably proven through the detection of mycobacteria in the patient’s tissues or biological fluids. The process of identifying these bacteria is quite long, since their reproduction time is about 20 hours. As a result, it takes doctors four to eight weeks to isolate the infection from a tissue sample.

There is also a method called a subcutaneous tuberculin test, and it is also considered quite reliable, and the result can be detected within two days.

This looks like measuring the diameter of the compaction obtained as a result of the sample, which in the case of tuberculosis is at least 16 mm. Interestingly, such a reaction can be detected not only in a sick patient, but also in simply a carrier of the infection. However, the described method also has a drawback: the sample may turn out to be false positive due to its contact with a similar type of bacteria in the environment. In addition, in 15% of tuberculosis patients, such an analysis will not give any indicative result at all, which may be caused by some of their painful conditions or weakened immunity.

Treatment

Intestinal tuberculosis is a difficult disease to treat. The doctor should recommend lifestyle changes to the patient and prescribe specific anti-tuberculosis therapy.

Such patients are usually treated on an outpatient basis. Indications for hospitalization may be poor tolerability of medications or the development of complications of the disease.

Localization in the gastrointestinal tract is characterized by the fact that the patient practically does not release mycobacteria into the environment and cannot infect others. Cases of household fecal-oral contact are quite rare and are possible in children due to poor hygiene.

Lifestyle

How should you live with gastrointestinal tuberculosis? To achieve a speedy cure for the disease, it is necessary to use both medicinal and non-pharmacological treatment methods. The latter include the following activities:

1. Spend more time in the fresh air, increase the body's nonspecific resistance.
2. Eat right - exclude fatty, fried foods, alcohol of any strength.
3. Eat small meals, avoid intestinal overload.
4. Add more proteins and easily digestible fats to your diet. It is necessary to fortify your diet with vegetables and fruits.
5. Prolonged constipation, weight gain, and overeating are unacceptable with a disease such as intestinal tuberculosis.

Don't forget about physical activity. Exercise helps increase the body's resistance and improve immunity. With this approach to treatment, recovery will be achieved much faster.

Medicines

Modern treatment of patients with tuberculosis of any location involves the use of combined chemotherapy regimens. 4 or more medications are prescribed for a long period of time. The intestinal process is no exception.

Treatment with specific drugs is associated with certain side effects. If unpleasant symptoms occur, you should consult a doctor, but do not stop taking the medicine. Changing the dosage of medications on your own is also strictly prohibited. This can lead to microbial resistance and treatment failure.

During therapy, symptomatic medications are also prescribed:

• Enzyme preparations (Pancreatin, Creon, Mezim) in the presence of symptoms of digestive insufficiency.
• Iron supplements for the correction of anemia.
• Non-steroidal anti-inflammatory drugs - with caution for pain, may increase damage to the intestinal wall.
• Detoxification solutions and parenteral nutrition for severe disease.
• Laxatives for constipation.

Any drug treatment must be prescribed by a specialist. It is prohibited to change the treatment regimen on your own.

Operation

Uncomplicated forms of the disease do not require the use of surgical treatment methods. This process is treated with long-term chemotherapy.

Surgeon intervention is indicated for:

1. Development of intestinal bleeding without the possibility of conservative stoppage.
2. Acute intestinal obstruction of an organic nature.
3. Penetration of a tuberculous ulcer into a nearby abdominal organ.
4. Development of peritonitis.

Options for surgical access are laparotomy - dissection of the abdominal wall tissue, or laparoscopic - intervention using small instruments through punctures in the abdominal wall.

Complications such as peritonitis require major surgery followed by planned sanitation of the abdominal cavity.

Nutrition and diet

For this disease, it is recommended to eat foods that are easily digestible. Patients with intestinal tuberculosis are prescribed high-calorie foods:

• soups (low-fat);
• meat cutlets (beef, poultry, rabbit, chicken and turkey);
• fresh boiled fish;
• cottage cheese;
• scrambled eggs;
• omelette;
• butter;
• milk;
• kefir;
• porridge with milk (rice, oatmeal, semolina);
• fresh fruit juices;

The following should be excluded from the diet:

• pork;
• goose meat;
• lamb;
• smoked meats;
• legumes;
• canned food

Often, patients with intestinal tuberculosis experience digestive system disorders (diarrhea, nausea, vomiting, abdominal pain), but these symptoms may indicate not only this disease, so it is important to conduct a competent differential diagnosis. When using synthetic drugs, intestinal upset may also occur. This condition develops especially often during treatment with PASK.

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If a patient has severe diarrhea, the doctor must adjust his diet. The following foods are removed from the diet:

• black bread, white crackers;
• raw vegetables;
• fruits;
• restriction in meat consumption.

Patients should never self-medicate, as this can have a detrimental effect on their health.

A prerequisite for the development of a specific process in the intestine is the penetration of mycobacteria there, which is possible in several ways:

Prevention

It is possible to prevent the development of the tuberculosis process; for this purpose, methods of primary and secondary prevention are used. These include:

• BCG vaccination in childhood.
• Avoiding contact with tuberculosis patients.
• Good nutrition, avoiding fasting.
• Timely detection and treatment of pulmonary forms of the disease.
• Prevention and treatment of inflammatory bowel diseases.
• Sanitary control over the state of food at the state level, especially dairy products.

Prevention of complications is achieved through complete treatment of the underlying disease. During chemotherapy, adverse consequences develop quite rarely.