Title: Understanding Tuberculous Peritonitis: A Comprehensive Guide for Modern Family Doctors
Overview: Tuberculous peritonitis, a chronic, disseminated peritoneal infection caused by Mycobacterium tuberculosis, is a significant health concern. This article provides an in-depth look at the disease, its diagnosis, treatment, and preventive measures, offering valuable insights for family doctors and healthcare professionals.
Understanding Tuberculous Peritonitis: Tuberculous peritonitis arises typically from pulmonary tuberculosis or other systemic tuberculosis foci. It can spread directly from intra-abdominal tuberculous foci or, less commonly, via lymphatic or hematogenous dissemination, leading to miliary tuberculous peritonitis. The disease is categorized into three types based on its pathological characteristics: exudative, adhesive, and caseous, with exudative and adhesive types being most common.
Diagnosis: Early symptoms are often subtle and may be missed, with a minority presenting with acute onset symptoms like acute abdominal pain or sudden high fever. Common symptoms include fever (low to moderate), night sweats, weight loss, and malnutrition. Abdominal pain, bloating, and abdominal mass formation are common, with abdominal fluid formation occurring in about a third of cases.
Laboratory tests, including blood count, sedimentation rate, tuberculin skin test, and T-SPOT tests, are key diagnostic tools. The ADA level in abdominal fluid can be elevated, but care must be taken to rule out malignancies. Laparoscopy and tissue biopsy are valuable for diagnosis. It is crucial to differentiate tuberculous peritonitis from other conditions such as abdominal malignancies, liver cirrhosis, and other abdominal pathologies.
Treatment: Supportive care includes bed rest, high-protein, high-calorie, and high-vitamin diets, and regular injections of albumin when necessary. Antituberculosis therapy is the cornerstone of treatment, often involving a combination of four drugs: isoniazid, rifampicin, ethambutol, and pyrazinamide or streptomycin. Duration of therapy can range from 2 to 7 months, depending on the type of disease. For abdominal fluid accumulation, intermittent paracentesis followed by the intraperitoneal injection of drugs such as isoniazid and streptomycin is recommended. In severe cases, corticosteroids may be added to reduce systemic symptoms and prevent complications.
In cases of complete or incomplete bowel obstruction, acute bowel perforation, or intractable abdominal abscesses, surgical intervention may be necessary. The prognosis is generally good with appropriate treatment.
Prevention: Early diagnosis and treatment of tuberculosis in the lungs, intestines, and other organs can significantly reduce the incidence of tuberculous peritonitis. Family doctors should remain vigilant for early signs of tuberculosis and promote effective antituberculosis treatment to prevent this serious condition.
Conclusion: Family doctors play a pivotal role in the early detection and management of tuberculous peritonitis. By understanding the disease's characteristics, diagnosis, and treatment options, healthcare professionals can provide comprehensive care to patients, improving outcomes and reducing the burden of this condition in the community.