modern family physician: understanding tuberculous peritonitis

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Overview

Modern Family Physician: Understanding Tuberculous Peritonitis

Overview

Tuberculous peritonitis, a chronic and diffuse peritoneal infection caused by Mycobacterium tuberculosis, is a serious condition that can arise following tuberculosis in the lungs or other parts of the body. This article delves into the causes, diagnosis, treatment, and prevention of tuberculous peritonitis, providing essential information for medical professionals and patients alike.

Causes and Pathology

Tuberculous peritonitis primarily develops through the direct spread of tuberculosis foci within the abdominal cavity, with a few cases involving lymphatic or hematogenous dissemination. The disease can manifest in three types: exudative, adhesive, and caseous, with exudative and adhesive types being most common.

Diagnosis

Symptoms of tuberculous peritonitis can be subtle, often presenting with low-grade fever,盗汗 (night sweats), and general malaise. In advanced stages, patients may exhibit symptoms of malnutrition, such as anemia, weight loss, edema, and vitamin A deficiency. Abdominal pain, bloating, and ascites (abdominal fluid accumulation) are common, and palpation may reveal a "rice-water" consistency in the abdomen. Laboratory tests, including a positive tuberculin skin test or T-SPOT test, can aid in diagnosis, as can the detection of increased adenosine deaminase (ADA) activity in ascitic fluid.

Treatment

Treatment for tuberculous peritonitis involves a comprehensive approach:

1. Supportive Care: Rest, high-protein, high-calorie, and vitamin-rich diets, and nutritional support are crucial.
2. Medication: Antituberculosis drugs, typically a combination of three or four medications, are prescribed. This includes isoniazid, rifampin, ethambutol, and pyrazinamide or streptomycin.
3. Ascitic Fluid Management: Intermittent paracentesis may be necessary, with medications like isoniazid and streptomycin injected into the abdominal cavity after fluid removal.
4. Corticosteroids: For severe systemic symptoms, corticosteroids may be added to the treatment regimen.
5. Surgical Intervention: In cases of complete or incomplete intestinal obstruction, or when complications like acute intestinal perforation or abscesses are present, surgery may be required.

Prevention

Prevention involves early diagnosis and treatment of tuberculosis in the lungs and other organs, such as the intestines, mesenteric lymph nodes, and fallopian tubes.

Conclusion

Tuberculous peritonitis is a complex condition that requires prompt and appropriate medical intervention. Early diagnosis and treatment, along with supportive care, can significantly improve outcomes. For individuals at risk, early detection and treatment of tuberculosis are key to preventing this serious condition.