Intestinal tuberculosis

　　Intestinal tuberculosis is a chronic specific infection caused by Mycobacterium tuberculosis invasion of the intestinal tract. Intestinal tuberculosis is a common disease in developing countries, but its incidence has been increasing in the UK and North America recently. It can be infected by swallowing sputum containing Mycobacterium tuberculosis and drinking unsterilized milk, and can also be caused by the direct spread of tuberculosis from adjacent organs, or by hematogenous spread of extraintestinal tuberculosis to invade the intestinal tract. Overwork and malnutrition are often triggering factors.

　　The predisposed sites of intestinal tuberculosis are in order of the ileocecal junction, ascending colon, ileum, jejunum, appendix, transverse colon, descending colon, duodenum, sigmoid colon, and rectum, among which the ileocecal junction accounts for 80% to 90%. Intestinal tuberculosis can be divided into ulcerative type (accounting for 60%), hyperplastic type (accounting for 10%), and mixed type (accounting for 30%) in gross morphology. Caseous necrosis is a characteristic pathological change of intestinal tuberculosis.

　　Intestinal tuberculosis mainly has two complications.

　　Intestinal obstruction is the most common complication of this disease, mainly occurring in hyperplastic intestinal tuberculosis, often caused by annular stenosis of the intestinal wall, peritoneal adhesions, mesenteric contraction, and twisted deformation of intestinal loops. Obstruction is chronic and progressive, with incomplete intestinal obstruction being more common, varying in severity, and a few cases can develop into complete intestinal obstruction. The main clinical symptoms of intestinal obstruction are abdominal pain, vomiting, abdominal distension, and cessation of flatus and defecation. In addition, the clinical symptoms of intestinal obstruction include disturbances in water, electrolytes, and acid-base balance. In cases of strangulated obstruction or intestinal necrosis, shock, peritonitis, and gastrointestinal bleeding may occur.

　　Intestinal perforation, mainly subacute or chronic perforation, can form abscesses in the abdominal cavity, and after rupture, form intestinal fistulas. Acute perforation is rare. It often occurs in the dilated intestinal loops near the obstruction, and severe cases can lead to peritonitis or septic shock and death due to complications of intestinal perforation. The clinical manifestations of intestinal perforation include: sudden onset of abdominal pain,呈持续性刀割样疼痛，and exacerbated during deep breathing and coughing; the range of pain is related to the extent of peritonitis; systemic symptoms of infection and intoxication, such as fever, chills, increased heart rate, and decreased blood pressure; decreased abdominal breathing or its disappearance, marked tenderness and rebound pain throughout the abdomen, muscular rigidity, liver dullness on percussion, possibly mobile dullness, and decreased or absent bowel sounds.

　　1. Abdominal pain is often located in the lower right abdomen or around the umbilicus, commonly呈阵发性绞痛，and accompanied by marked intestinal sounds, but it can also be a persistent dull pain in the lower right abdomen. The onset of abdominal pain may be irregular, but it can also be triggered by eating.

　　2. Changes in defecation regularity, diarrhea, constipation, or alternating diarrhea and constipation; ulcerative cases are mainly characterized by diarrhea. It may also show no obvious change in defecation, but mainly表现为 chronic abdominal pain. Diarrhea may present with mucoid or watery stools, 3-6 times a day, often accompanied by anal pain before defecation, rarely with mucopurulent stools, and hematochezia is also rare.

　　3. In cases with obvious consumptive lesions, weight loss is common.

　　4. Toxic reactions of tuberculosis bacteria, such as fever, night sweats, and weakness (such symptoms are rare in hyperplastic cases).

　　5. Other symptoms of the digestive system, such as nausea, vomiting, loss of appetite, and abdominal distension.

　　6. In the late stage of intestinal stenosis, symptoms of partial or complete intestinal obstruction may occur (common in hyperplastic cases); intestinal adhesions are also not uncommon.

　　7. Physical examination shows hyperactive bowel sounds, tenderness in the lower right abdomen, and a mass may be palpable in the lower right abdomen in some patients.

　　To prevent intestinal tuberculosis, it is necessary to know the causes of intestinal tuberculosis: most cases are caused by Mycobacterium tuberculosis. In addition, drinking unsterilized dairy products can lead to infection by Mycobacterium bovis. Intestinal tuberculosis infection can occur through oral ingestion, hematogenous dissemination, and spread from adjacent organs with tuberculosis. The onset of tuberculosis is the result of the interaction between the human body and the tuberculosis bacteria. To prevent the spread of tuberculosis, it is recommended to use a communal spoon or separate meals for patients with pulmonary tuberculosis, to drink sterilized milk and dairy products, and to disinfect the feces of patients with intestinal tuberculosis.

　　Pay attention to rest and nutrition, and eat less food with no nutritional value. Not only does it not help to increase nutrition, but it is also easy to trigger diseases.

　　To enhance the body's ability to resist diseases, it is essential to engage in more physical activities, especially aerobic exercises such as running, cycling, swimming, and yoga, which are popular among women. Only when the body's resistance is improved will diseases be kept at bay.

　　1. Tuberculin skin test positivity and chest X-ray showing active pulmonary tuberculosis are useful clues, but they can also be completely negative.

　　2. Barium meal and barium enema examination shows紊乱 of intestinal mucosal folds, thickening, ulcer formation, irritation, concentric multiple intestinal strictures, rigidity of the intestinal tract, shortening and deformation, and pseudopolyp signs. The intestinal stricture is shorter than that in Crohn's disease. The ileocecal junction is involved as a whole unit, meaning that lesions are visible on both sides of the ileocecal valve. If only the ileum is involved, other diagnoses should be considered. It is noteworthy that in barium meal examination, to avoid exacerbating intestinal obstruction, dilute barium can be used if necessary.

　　3. Colonoscopy shows mucosal congestion, edema, annular ulcers, inflammatory polyps, and intestinal stricture, and biopsy can be taken. If there is caseous necrosis, it can be diagnosed as tuberculosis.

　　4. Laparoscopic examination shows grayish-white small nodules on the intestinal serosal surface, and biopsy shows typical tuberculosis changes.

　　5. Polymerase chain reaction (PCR) technology has opened up a new path for the diagnosis of tuberculosis etiology in recent years.

　　6. Other examinations may show anemia and an increased erythrocyte sedimentation rate.

　　Patients with intestinal tuberculosis should pay attention to the supplement of various nutrients to ensure an adequate supply of calories, vitamins, and proteins. Patients with long-standing illness and weakened bodies should consume more nourishing foods. Control the intake of fat. Avoid spicy, hot, dry, and aromatic foods such as chili, ginger, and mutton, as well as smoking, alcohol, and coffee.

　　The dietary therapy for intestinal tuberculosis includes:

　　1) One tender young chicken (wuta chicken is better), 20 grams of astragalus, 3 grams of American ginseng, 10 grams of stemona, 30 grams of bamboo shoots, and 3 slices of cooked ham. Simmered over low heat for 2 hours before serving.

　　2) One whole young duck, 10 grams of cordyceps sinensis, stuffed into the duck's abdomen, seasoned, and steamed for 2 hours before serving.

　　3) One live softshell turtle (about 500g), seasoned, steamed until tender and well-cooked before serving.

　　4) 20 grams of lily, 10 grams of ophiopogon, 10 grams of stemona, all are decocted together to obtain the juice, which is then mixed with 100 grams of glutinous rice to make porridge for consumption.

　　5) Some purple garlic.

　　Usage: The first course is 10 days, 3 times a day, 25g each time; the second course is 20 days, 3 times a day, 20g each time; the third course is 30 days, 3 times a day, 15g each time; the fourth course is 12 months, maintaining a dose of 2 times a day, 10g each time, all taken during meals. If it is changed to white skin garlic, the dosage is doubled.

　　6) Fresh amaranth 300g, frog 2 (about 150g), garlic 60g, mung beans 60g, glutinous rice 60g.

　　Usage: First, peel and remove the internal organs of the frog; wash the other ingredients clean. Put the amaranth in the pot, add an appropriate amount of water, cook over low heat for half an hour, remove the residue and take the juice, add glutinous rice, mung beans, garlic, and frog to cook for 1 hour, and season and eat.

　　7) Fresh Portulaca oleracea 1500g, yellow wine 1250 milliliters.

　　Usage: Wash the fresh Portulaca oleracea clean, crush it, and soak it in yellow wine for 3-4 days. Filter the juice through gauze, store it in a porcelain bottle, and drink 15-20 milliliters before meals every day.

　　The goal of treating intestinal tuberculosis is to eliminate symptoms, improve the overall condition, promote the healing of the lesions, and prevent and treat complications. Emphasis is placed on early treatment because the early lesions of intestinal tuberculosis are reversible.

　　(1) Rest and nutrition. Rest and nutrition can strengthen the patient's resistance and are the foundation of treatment.

　　(2) Antituberculosis chemical drug treatment is the key to the treatment of this disease, and its principle is: early, regular, full course, appropriate dosage, and combination.

　　First-line antituberculosis drugs include isoniazid, rifampicin, streptomycin, pyrazinamide, ethambutol, and thiacetazone.

　　Second-line antituberculosis drugs include para-aminosalicylic acid, prothionamide, amikacin, capreomycin, rifapentine, and rifabutine.

　　(3) Symptomatic treatment. Abdominal pain can be treated with anticholinergic drugs. Those with insufficient intake or severe diarrhea should pay attention to correct the disorder of water, electrolyte and acid-base balance. For patients with incomplete intestinal obstruction, gastrointestinal decompression is required.

　　(4) Surgical treatment. Indications include: ①Complete intestinal obstruction; ②Acute intestinal perforation, or chronic intestinal perforation fistula formation that has not closed after medical treatment; ③Large amounts of intestinal bleeding that cannot be stopped effectively after active rescue; ④Difficult diagnosis requiring laparotomy.