ABDOMINAL TB😍

String Sign:

• TB

• CHPS

• Crohns Disease

Renal Tuberculosis

Features:

• Secondary infection (hematogenous spread).

Presentations:

Renal

• Papillary Ulcers → Ghost calyx/Pseudo calculi → Caseous necrosis → Pus filled kidney → Calcification ("Putty" or "Cement" kidney).

Ureter

• Kirrs Kink
• Bending of ureter

• Shortening of ureter

• Golf hole ureteric orifice
• Orifice remain open

• Pale ureteric orifice
• Indicates inflammation and edema of surrounding mucosa
• Early sign

Clinical Features:

• Hematuria, pain, mass, weight loss.

Putty kidney

• Cement (amorphous calcification) + lobulated appearance = parenchymal calcification

• Moth eaten calyces
• Earliest sign in the IVP for renal TB
• irregularity of the calyx.

• Later stages of TB

• → non-functional kidney and auto-nephrectomy.

• Sterile pyuria is seen in urinary TB.

Corkscrew and Beaded appearance

• Multiple ureteric strictures

Thimble bladder

• small, contracted bladder

• Heal with fibrosis
• bladder wall calcification

Investigations:

• Urine examination: Sterile pyuria (pus cells +, culture -).

• Confirmatory:
• ZN Staining of centrifuged 3 morning urine samples.

Note:

• If genital TB
• Genital swab for polymerase chain reaction (PCR) testing

Treatment:

• Medical: Anti-tubercular treatment (ATT).

• Surgical (for complications):
• Perinephric abscess:
• Drainage.

• Ureteric kinking:
• DJ stenting.
• "Golf Hole" ureteric orifice:
• Ureteric reimplantation.
• "Thimble Bladder":
• Augmentation cystoplasty.
• Lower ureter damage:
• Boari flap repair.

• Most common cause of PID in virgin females: Genital TB
• Hematogenous spread
• Affect Ampulla

B/L Cornual block (better outcome):

• Most common cause: Physiological spasm

• Most common pathological cause: Genital TB

• (before Lap chromopertubation → perform hysteroscopic cannulation)
• Hysteroscopic cannulation
• Passing thin wire: Relieves physiological spasm

• If block persists after laparoscopic chromopertubation:
• Genital TB treatment → IVF

• After T/T if HSG is done

• In fallopian tubes:
• B/L cornual block
• Beaded appearance
• Cotton wool appearance
• Golf stick appearance
• Lead pipe appearance
• Tobacco pouch appearance

• In uterine cavity:
• Multiple filling defects + irregular borders
• (due to Asherman syndrome)

Tuberculosis of Larynx

• Association: Often with pulmonary tuberculosis.

• Involvement:
• Commonly, posterior part of the larynx is involved first.
• Anterior part is involved last.

• Pain: Extremely painful condition ?????
• Not very painful, not painless

Earliest Signs:

• First sign: Hyperaemia, sluggish movement of vocal cords.

• Mamillated arytenoids.

• Mouse-bitten or moth-eaten appearance.

• Last sign: Turban epiglottis.

Diagnosis:

• Culture/histopathology/gene expert/molecular methods for TB.

Treatment:

• ATT (Anti-tuberculosis therapy).

Lupus of Larynx

• A low-grade infection of TB.

• Involvement:
• Affects the anterior part of the larynx;
• epiglottis is first involved.

Laryngeal Papilloma

• Definition: Finger-like projections.

• Cause: HPV 6, HPV 11.

Juvenile-Onset Laryngeal Papillomatosis

• Age: Infants, young children.

• Transmission: Mother to child during vaginal delivery.

• Location: True/false vocal cords, epiglottis, subglottis.

Presentation:

• Voice change

• airway obstruction

• respiratory distress

• stridor.

Recurrence:

• Aggressive recurrence is common.

Treatment:

• Tracheotomy is C/I
• Intubation preferred

• Microlaryngeal excision :
• Microdebrider (TOC) > CO2 laser.

To ↓ recurrence : ABC

• α interferon (Immunomodulator)

• Bevacizumab

• Cidofovir (Intralesional)

Adult-Onset Laryngeal Papillomatosis

• Age: 30-50 years.

• Transmission: Sexual.

• Single

• Location:
• Anterior half of the vocal cord or anterior commissure.

• Presentation:
• Voice change, airway obstruction, respiratory distress, stridor.

• Recurrence:
• Less aggressive;
• does not recur after excision.

• Treatment: Antivirals, interferons, debrider-assisted resection.