TUBERCULAR ULCER | TYPHOID ULCER | |
---|---|---|
Causative organism | Mycobacterium tuberculosis , Acid fast bacteria | Salmonella typhi.,gram negative bactria |
Distribution | Ileocecal region, Rarely other parts of GI tract | Most often small intestine, Terminal ileum is most common location. Can be seen in jejunum or rarely colon |
Spread | via hematogenous spread, ingestion of infected sputum, OR direct spread from infected contiguous lymph nodes and fallopian tubes. | Typhoid is spread by poor sanitation and poor hygiene.Feco- oral route |
CLINICAL FEATURES | ||
Fever | Low grade fever, weight loss | Fever with chills, stepladder type of fever |
Diarrhea/ constipation | Chronic diarrhea, features of obstruction | Constipation common, diarrhea rare |
Abdominal pain | Present , long standing, may be colicky | Very common, may eb sudden onset |
Abdominal mass | Sometimes | Unlikely |
Ascitis | Common | Unlikely |
MACROSCOPY | ||
Ulcer arrangement | Transverse axis of the intestine- longest diameter perpendicular to the long axis of the gut | Longitudinal axis - longest diameter parallel to the long axis of the gut |
related to the direction in which the lymphatic vessels run in the wall of the ileum | Organism, accumulates in lymphoid tissue in Peyer’s patches | |
infection tends to spread along these lymphatics. | and causes the patches to become inflamed and ulcerated. | |
Size and margins | Large, Irregular and can be involve the entire circumference | Small, variable . regular and ovoid |
Base of ulcer | Creamy white , if caseous necrosis is present | Blackish , due to mucosal sloughing |
Depth of ulcer | Depth of ulcer | Superficial and deep |
Serosal surface | Often Show tubercles | Smooth unless there is perforation |
MICROSCOPY | ||
Type of inflammation | Chronic | Non-specific, often acute |
Granulomas | Present | Absent |
Erythrophagocytosis | Absent | Present . S. typhi survives intracellularly in macrophages.The bacilli stimulate macrophages to engulf erythrocytes!! |
COMPLICATIONS | ||
Bleeding | Uncommon | Common, Due to erosion of adjacent vessels |
Perforation | Uncommon | present, most serious complications of typhoid fever |
Stricture | present as a result of fibrosis | Absent |
TREATMENT | Antitubercular drugs, Strictures/ obstruction- surgical intervention | Antibiotics, If complications ( bleeding/ perforation )- surgical/ medical intervention |
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