Tuberculous Peritonitis

DEFINITION
Tuberculosis affecting the peritoneum.
See also TB card.
See also tuberculous enteritis card.
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EPIDEMIOLOGY
See TB card.
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AETIOLOGY
TB
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BIOLOGICAL BEHAVIOUR

Pathophysiology

The peritoneum is the 6th most common site of extrapulmonary TB (Sabiston).
- after: lymph, GU, bone, & joint, miliary and meningeal.
Most relate to reactivation of latent peritoneal disease previously established haematogenously from a primary pulmonary focus.
- only 1/6th associated with active pulmonary disease.

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MANIFESTATIONS

Symptoms

Often insidious, pts having symptoms for weeks to months.
Local
Ascites = most common symptom (80% - Sabiston).
Abdominal pain possible.
Systemic
Fever, weight loss.
Metastatic / Complications
Other sites of TB
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INVESTIGATIONS

Biochemistry

Ascitic fluid <1.1g?dL
Erythrocytes and leukocytes seen, mostly lymphocytes.

Microbiology

TB skin test positive in most.
Micro identifies acid-fast bacilli in <3% of ascitic fluid cases (Sabiston).
- and culture only successful in 20%.
- and takes up to 8 weeks.
Adenosine deaminase
An enzum that catabolises purine bases.
- levels are increased in TB peritonitis from stimulation of T-lyphocytes by mycobacterial antigens.
- high level of accuracy (Sabiston)

Imaging

50% will have an abnormal CXR.

Laparoscopy

Best  means of diagnosis.
Biopsy the peritoneum.
= presumptive diagnosis in 90% (Sabiston)
- aim for the white nodules (<5mm) seen on visceral and parietal peritoneum.
- histo = caseating granulomas in ~90% (Sabiston)



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MANAGEMENT
Antituberculous drugs.
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REFERENCES
Sabiston 17th