TUBERCULAR ULCERTYPHOID 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
Spreadvia 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 colickyVery 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 gutLongitudinal 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 ileumOrganism, 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 surfaceOften Show tubercles Smooth unless there is perforation
MICROSCOPY
Type of inflammation Chronic Non-specific, often acute
Granulomas Present Absent
Erythrophagocytosis AbsentPresent .
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
TREATMENTAntitubercular drugs,
Strictures/ obstruction- surgical intervention
Antibiotics,
If complications ( bleeding/ perforation )- surgical/ medical intervention