A 15 year old female presented with complaints of Diarrhoea (on/off) since 2 months, Fever and Anorexia since 1.5 months....She had lost around 5 kg body weight in 2 months...Her reports are given...comment on her condition and treatment approach to this pt

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Diffuse infiltration with multiple cavitary lesions with Rt fissural hazziness with obliterated Lt cp angle suggested minimal pleural effusion with compensatory emphysema. Inflammatory bowel disease DD 1 PTB with Koch's abdomen 2 PTB with HIV

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Xray chest shows blunting of lt cp angle with infiltrates in rt mid zone with h/ofever and anorexia and wt loss and freqent loose motions usg supports inflamatory bowel disease reflected by hemogram with leucocytosis predominantly polys. Lfts shows mild deranged as slight increased sgot with usg shows echos in liver. However high ALP 800mg could not be explained. In my opinion it is a case of koch's chest with inflammatory bowel disease. To see koch's abdomen stool examination and culture for afb will be supporting or go for Ba meal of whole gi track so as to look for cord like intestine otherwise treat as pulmonary tuberculosis

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Left cp angle oblitrate with rt middle lobe infiltration Pulmonary Koch's Edematous bowel with LM To r /o abdominal Koch's Berium meal follow through Sputum /pleural Fluid /stool AFB, R /M and C /S by bactaet method ESR MT, TB gold, TB genexpert, CRP Further management as per report

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Multiple cavitory leison seen in rt mid and lower zone of lung Fever ,wt loos of 5 kg ,diarrhea Feature are suggesting of pul tuberculosis With abdominal tuberculosis Regarding tt and investigation Do sputum for Afb and mgit ,pleural fluid investigation CT abdn Start AKt , go for sero status ,go for stool for routine micro,iv fluid , antibiotic of your choice , Colonoscopy after stablizing patient And G I surgeons opinion

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X ray chest shows RT.Lung infiltration, TC and Lymphocytes increase ,USG shows dilated loop all evidence goes towards Koch's chest and Intestinal Tuberculosis but sir must ask for Sputum for AFB, CBNNAT and ESR Blood SUGAR, HIV before starting ATT as per GUIDELINE of WHO

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Disseminated kochs pulmonary abdominal Sputum afb Colonoscopy biopsy Do lft Start att once confirmed

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Koch's abd and chest with pleural effusion lt. CT scan of chest Pleural fluids analysis

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INTESTINAL TUBERCULOSIS PULMONARY TUBERCULOSIS

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Left pl effusion Rt mid and lwr zn Dgx Bilateral ptb And Possibly abdominal tb aldo

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Pulmonary Koch's, spraid up to intestinal Koch's. USG.(abdomen) may be conducted,treat as per report.

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