Presentation
An exquisite art program that focuses on clarity of presentation with an emphasis on anatomy, pathology, patient presentation, and clinical context. [books.google.com]
The variable clinical presentations with no consistent clinical and biochemical features makes diagnosis of hepatic tuberculosis very difficult. Usually the presentation is non specific and constitutional in nature. [pubs.sciepub.com]
Similarly, isolated hepatic tuberculosis presenting as jaundice and abdominal distension has been reported in literature by Shastri et al. [ 9 ] However, hepatic TB presenting as acute liver failure has not been reported in literature. [academic.oup.com]
The clinical presentation of ILT is so rare and atypical that it challenges the clinical acumen of the treating physician ( 2 ). [ispub.com]
Here we did a case study of disseminated tuberculosis with unusual presentation. [omicsonline.org]
Entire Body System
- Fever
She developed incontinence of urine and was brought to our medical centre with fever, episodic unconsciousness and incontinence of urine. [jpma.org.pk]
On the other hand, the absence of epidemiologic features and cardiac valvulopathy made the diagnosis of brucellosis and Q fever less likely. [elsevier.pt]
The clinical presentation of hepatic tuberculosis includes epigastric pain, mild fever, jaundice, lethargy, hepatomegaly, splenomegaly, raised alkaline phosphatase, raised GGT, leucocytosis, raised ESR and as fever of unknown origin. [pubs.sciepub.com]
Etiology/Pathogenesis • Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly, fever [basicmedicalkey.com]
Group of Hospitals, Bikaner with complaints of diarrhoea, fever with chills and rigor, pain in the abdomen and a swelling in the right hypochodrium for 40 days. The onset was gradual with increasing weakness and deterioration of the general health. [jpgmonline.com]
- Weight Loss
Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly, fever, abdominal pain, weight [basicmedicalkey.com]
The most common symptoms were fever and weight loss. Risk factors were present in 70% of cases, mainly diabetes mellitus, history of prior tuberculosis, chronic liver and renal disease, immunosuppressive drug therapy and malignancy. [ingentaconnect.com]
loss Weakness and fatigue Chills, night sweats are common Cough Hemoptysis Anorexia Hepatomegaly and lymphadenopathy are common Imaging Findings Takes weeks between the time of dissemination and the radiographic appearance of disease Up to 30% have a [learningradiology.com]
Symptoms of the disease are commonly non-specific and include fever, vague abdominal pain, anorexia and weight loss [ 8 ]. [hepatitis.imedpub.com]
Biopsy from the retroperitoneal nodes revealed metastases from mucinous adenocarcinoma Fig. 5 a Axial contrast-enhanced CT of a 55-year-old woman with fever and weight loss exhibits multiple hypodense lesions ( arrows ) in the right lobe of the liver. [link.springer.com]
- Chills
Group of Hospitals, Bikaner with complaints of diarrhoea, fever with chills and rigor, pain in the abdomen and a swelling in the right hypochodrium for 40 days. The onset was gradual with increasing weakness and deterioration of the general health. [jpgmonline.com]
[…] meningitis Risk Factors Immunosuppression Cancer Transplantation HIV Malnutrition Diabetes Silicosis End-stage renal disease Clinical Findings Onset is insidious Patients may not be acutely ill Symptoms include Fever and weight loss Weakness and fatigue Chills [learningradiology.com]
They include weight loss, fever, chills, weakness, general discomfort, and difficulty breathing. Infection of the bone marrow may cause severe anemia and other blood abnormalities, suggesting leukemia. [merckmanuals.com]
Symptoms depend on the affected areas of the body and can include: Abdominal pain or swelling Chills Cough and shortness of breath Fatigue Fever General discomfort, uneasiness, or ill feeling ( malaise ) Joint pain Pale skin due to anemia (pallor) Sweating [medlineplus.gov]
The signs and symptoms exhibited by Disseminated Tuberculosis depend on the part of the body affected and may include: Persistent cough that can be blood-tinged Fatigue for a prolonged time period Fever that can be mild or severe, sweating, and chills [dovemed.com]
- Rigor
Group of Hospitals, Bikaner with complaints of diarrhoea, fever with chills and rigor, pain in the abdomen and a swelling in the right hypochodrium for 40 days. The onset was gradual with increasing weakness and deterioration of the general health. [jpgmonline.com]
Case presentation A 30-year-old man of Asian origin, presented to the surgery outpatient department (OPD) with non-radiating pain in the right hypochondrium and epigastrium associated with vomiting, intermittent fever with chills and rigors for 10 days [jmedicalcasereports.biomedcentral.com]
- High Fever
In children it is associated with high fever, night sweats, and often meningitis, pleural effusions, or peritonitis. [medical-dictionary.thefreedictionary.com]
Respiratoric
- Respiratory Insufficiency
On day three, the patient died due to respiratory insufficiency and multi-organ system failure. [pulmonarychronicles.com]
- Rales
Signs and Symptoms Patients typically present with weight loss, fatigue, a productive cough, fever, and night sweats Physical Examination Dullness to chest percussion, rales Auscultation revealed vocal fremitus sound Laboratory Tests Moderate [slideshare.net]
Gastrointestinal
- Abdominal Pain
The most common clinical findings are abdominal pain, fever and weight loss. Hepatomegaly is frequently found. [academic.oup.com]
/Pathogenesis • Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly, fever, abdominal [basicmedicalkey.com]
Symptoms of the disease are commonly non-specific and include fever, vague abdominal pain, anorexia and weight loss [ 8 ]. [hepatitis.imedpub.com]
During the first few days of hospital stay, there was improvement of right upper abdominal pain but afterwards the patient started to complain of a precordial sharp pain worsening with deep inspiration and had evening fever (up to 39.5 °C), with chills [elsevier.pt]
Symptoms depend on the affected areas of the body and can include: Abdominal pain or swelling Chills Cough and shortness of breath Fatigue Fever General discomfort, uneasiness, or ill feeling ( malaise ) Joint pain Pale skin due to anemia (pallor) Sweating [medlineplus.gov]
- Loss of Appetite
But the common symptoms include fatigue, weight loss, loss of appetite, and fever. [dovemed.com]
A 64-year-old Portuguese male was admitted with epigastric and right upper quadrant pain associated with low grade fever, fatigue, nausea, anorexia, weight loss (6 kg) and mild jaundice. [elsevier.pt]
- Abdominal Tenderness
Symptoms include abdominal pain, diarrhea, weight loss, and fever. Melena, rectal bleeding, and abdominal tenderness also can be present. A mass in the right lower quadrant is palpable in 25 to 50 percent of patients. [aafp.org]
Liver, Gall & Pancreas
- Hepatomegaly
(+) patients Etiology/Pathogenesis • Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly [basicmedicalkey.com]
He was alert but appeared uncomfortable, had mild jaundice and moderate tenderness in the right upper abdomen with palpable hepatomegaly. [elsevier.pt]
Sonography abdomen revealed hepatomegaly with multiple hypoechoic lesions in the liver. Contrast enhanced CT scan abdomen showed hepatomegaly with multiple small hypodense lesions, minimal ascites. [pubs.sciepub.com]
Imaging features were as follows [patients ( n ) (%)]: (1) USG: hepatomegaly - 6/10 (60%), fatty liver - 5/10 (50%), nodularity - 1/10 (10%) and normal - 4 (40%); (2) CT and MRI: hepatomegaly - 8/10 (80%), nodularity - 4/10 (40%), fatty liver - 5/10 [ijpmonline.org]
Transplantation HIV Malnutrition Diabetes Silicosis End-stage renal disease Clinical Findings Onset is insidious Patients may not be acutely ill Symptoms include Fever and weight loss Weakness and fatigue Chills, night sweats are common Cough Hemoptysis Anorexia Hepatomegaly [learningradiology.com]
Cardiovascular
- Tachycardia
Electrocardiogram showed sinus tachycardia, abdominal ultrasonography revealed hepatomegaly and slightly coarse echotexture of the liver, suggesting hepatic steatosis and chest X-ray revealed only a small left pleural effusion. [elsevier.pt]
On examination, patient was drowsy; her BP was 102/70 mmHg but had tachycardia. She had pallor, icterus and ecchymotic patches on the trunk and extremities. On CNS examination Glasgow coma score was 6/15, neck rigidity and kernig's sign was absent. [academic.oup.com]
His vitals revealed a fever of 102 F, tachycardia, and tachypnea with an oxygen saturation of 92%. His head computed tomography was negative for any acute abnormalities, and an electroencephalogram was negative for any epileptiform activities. [jtd.amegroups.com]
Cardiomegaly, tachycardia, fever, pericardial rub, pulsus paradoxus, or distended neck veins may be found on examination. 41 Pericardial biopsy yields a definitive diagnosis more often than pericardial fluid alone. 41 In addition to antituberculous therapy [aafp.org]
Musculoskeletal
- Arthritis
Arthrocentesis with mycobacterial cultures of synovial fluid yields positive results in up to 80 percent of patients with tuberculous arthritis. [aafp.org]
Neurologic
- Stupor
In view of continuing fever, stupor and SIADH, a CT chest was performed which showed a pleural based soft tissue mass located at the basal portion of right hemithorax which could be aloculated pleural collection or mesothelioma. [jpma.org.pk]
If untreated, mental status deteriorates into stupor or coma. 31 Atypical presentations include a rapid progression simulating pyogenic meningitis, subtle cognitive decline mimicking dementia, and a predominant syndrome of encephalitis. [aafp.org]
Urogenital
- Hematuria
Patients present with dysuria, hematuria, or flank pain. 37, 38 More than 90 percent of asymptomatic patients have sterile pyuria with or without microscopic hematuria. 37, 38 Intravenous pyelography may show a “motheaten calyx” or papillary necrosis. [aafp.org]
Workup
Although most patients can be diagnosed based on sputum examination alone, a significant proportion need additional workup. Miliary tuberculosis is one such problem. [lungindia.com]
Biopsy
- Liver Biopsy
In recent years punch liver biopsy has been established as a simple, practical and safe method of obtaining a specimen of liver tissue satisfactory for microscopical study and causes very little discomfort to the patient. 4 5 6 7 8 Liver biopsy is not [nejm.org]
Fiberoptic bronchoscopy was diagnostic in 7/10 (70%), bone marrow examination in 8/11 (73%), and liver biopsy in 14/16 (88%). [ingentaconnect.com]
This is a very unusual presentation of a disease in which the correct diagnosis was achieved after performance of a liver biopsy. [elsevier.pt]
{image:1} {image:2} A percutaneous tru-cut biopsy of the liver was done but the result was inconclusive. Patient was operated for the purpose of frozen section biopsy and possibility of segmental resection. [ispub.com]
A liver biopsy was considered but in view of thrombocytopenia, management of hepatic enceplialopathy was started and liver biopsy deferred. [jpma.org.pk]
Treatment
Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances. [books.google.com]
A reasonable time to begin HIV treatment is after 2 months of TB treatment Influence of HIV Infection on Pathogenesis Introduction Etiology Epidemiology Pathophysiology Clinical features Diagnosis Treatment Pathogenesis of Tuberculosis 28. [slideshare.net]
Steroid treatment Steroid treatment ( prednisolone ) is recommended as an additional treatment for some forms of TB. [patient.info]
[…] regimen and to increase the duration of treatment. [tropicalgastro.com]
Surgical treatment is rarely necessary. [emedicine.medscape.com]
Prognosis
What is the Prognosis of Disseminated Tuberculosis? (Outcomes/Resolutions) With early diagnosis and prompt treatment, the prognosis of Disseminated Tuberculosis is generally good. [dovemed.com]
[…] usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly, fever, abdominal pain, weight loss • Tuberculoma/localized disease can mimic neoplasm and compress biliary tract, vessels • Mortality ranges from 10-40% Worse prognosis [basicmedicalkey.com]
Treatment may continue for 6-9 months 9-12 months with meningeal involvement Complications Dissemination via bloodstream to Lymph nodes Liver Spleen Skeleton Kidneys Adrenals Prostate Seminal vesicles Epididymis Fallopian tubes Endometrium Meninges Prognosis [learningradiology.com]
The poor prognosis of military TB can be mitigated by the early detection and rapid initiation of appropriate antituberculous medications. [pulmonarychronicles.com]
The prognosis in such cases is goods We are thankful to the Principal and Controller, S.P. Medical College and Associated Group of Hospitals, Bikaner, for permitting us to publish this case report. 1. Gracey, L.: Tuberculous abscess of the liver. [jpgmonline.com]
Etiology
Introduction Etiology Epidemiology Pathophysiology Clinical features Diagnosis Treatment 1. [slideshare.net]
Hepatic TB seen in ∼ 1% of patients with active TB More common in HIV(+) patients Etiology/Pathogenesis • Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved [basicmedicalkey.com]
During 6 years, a total of 280 consecutive patients with TB were evaluated prospectively for the presence and etiology of liver involvement. [ijpmonline.org]
[…] histopathological examination is the most reliable diagnostic method in case of hepatic tuberculosis. [ 9 ] In areas where tuberculosis is endemic, patients should be considered for empirical therapy with antitubercular drugs particularly when there is a lack of etiological [pubs.sciepub.com]
[…] biopsy was performed and histopathological examination ( Fig. 4 ) showed a diffuse and predominantly mononuclear cell infiltrate and epithelioid granulomas with central caseating necrosis suggestive of granulomatous hepatic inflammation of tuberculous etiology [elsevier.pt]
Epidemiology
Introduction Etiology Epidemiology Pathophysiology Clinical features Diagnosis Treatment 1. [slideshare.net]
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and [ingentaconnect.com]
Delineate the epidemiologic risk factors for the acquisition of TB infection, the subsequent development of TB disease in a minority of children, and the risk of multidrug-resistant TB. Describe the presenting signs and symptoms of TB in children. [pedsinreview.aappublications.org]
Miliary tuberculosis: epidemiology, clinical manifestations, diagnosis, and outcome. Rev Infect Dis 1990;12:583-90. BIEHL JP. Miliary tuberculosis; a review of sixty-eight adult patients admitted to a municipal general hospital. [jtd.amegroups.com]
Journal Journal ID (nlm-ta): Pan Afr Med J Journal ID (publisher-id): PAMJ Title: The Pan African Medical Journal Publisher: The African Field Epidemiology Network ISSN (Electronic): 1937-8688 Publication date (Electronic): 09 May 2011 Publication date [scienceopen.com]
Pathophysiology
Introduction Etiology Epidemiology Pathophysiology Clinical features Diagnosis Treatment 1. [slideshare.net]
This book in The Netter Collection of Medical Illustrations (the CIBA "Green Books") has been expanded and revised to capture current perspectives in hepatology, pancreatology, and gastroenterology - from normal anatomy and physiology through pathophysiology [books.google.com]
Pathophysiology of Miliary TB Following exposure and inhalation of TB bacilli in the lung, a primary pulmonary complex is established, followed by development of pulmonary lymphangitis and hilar lymphadenopathy. [emedicine.medscape.com]
The precise pathophysiologic pathway of triggering DIC in mycobacterial infection is unknown. [pulmonarychronicles.com]
Prevention
Seite 290 - Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta-analysis. Hepatology 1999; 29: 1655-61 6. [books.google.de]
Disseminated TB can be prevented by early diagnosis and treatment of pulmonary tuberculosis. [dovemed.com]
TB is a preventable disease, even in those who have been exposed to an infected person. Skin testing for TB is used in high-risk populations or in people who may have been exposed to TB, such as health care workers. [medlineplus.gov]
How can tuberculosis be prevented? TB is both preventable and treatable. It is a tragedy that it remains one of the biggest killers worldwide. [patient.info]
The Centers for Disease Control and Prevention has published "Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health Care Facilities." The document can be read on their web site at http://www.cdc.gov. Drugs. [medical-dictionary.thefreedictionary.com]