m Source of Infection:
1ry ® infected milk. 2ry. ® swallowed sputum.


mTypes:
1- Ulcerative; Commonest in the terminal ileum. The ulcers are transverse and multiple.
2- Hyperplastic; Commonest in the iliocaecal valve infiltrating the submucosa with chronic caseating granuloma which heals by fibrosis.
Both types cause mesenteric L.N. enlargement and caseation (Tabes mesenterica). In both types healing by fibrosis ® shortening & narrowing.
* Why the T.B. ulcer does not perforate?
As the serous coat is markedly thickened.
* Why the ulcers cause intestinal obstruction after healing?
As it lying transverse.

mClinical Picture:
1- Ulcerative type:
a- Blood and mucus / rectum b- Abdominal colic.
2- Hyperplastic type; May present with:
a- Mass in the Rt. iliac fossa.
b- Chronic intestinal obstruction (not acute) due to fluid content of the small intestine.
c- Vague pain in the Rt. iliac fossa with alternating attacks of diarrhea and constipation.
d- Abscess and fistula; which may be:
External ® open into the skin.
Internal ® open into the urinary bladder or vagina.

mInvestigations:


1- Barium follow thorough or (small bowel enema):
· Narrowing of terminal ileum. · Widening of the iliocaecal angle.
· Rapid emptying of the caecum, ascending colon and transverse colon (Barium jump).
· Shortening of the ascending colon.
2- Plain x-ray:
· Calcified lymph nodes (Tabes mesenterica).
mTreatment:
1- Medical:
· Anti T.B. drugs. · Sanatorium admision..
· Good nutrition.
2- Surgical treatment:
· Indications: Any complications e.g. mass, obstruction, fistula.
· Operations: 1- Rt. hemicolectomy.
2- Ilio-transverse colostomy if resection is difficult.
SOURCE: DR. AYMAN SALEM'S BOOK
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