? Tuberculer Ileal ulcer

A female aged 26 years Chief Complaints Pain Abdomen (on/off) (x 2 months) Colicky Intermittent Loss of weight Loss of appetite History Family history of TB positive in brother Physical Examination Pallor (+) Investigations EsR - 86 CRP - 35.4 Colonoscopy showed this type of transverse ulcer in distal ileum


Colonoscopy presenting well marked necrosed ulcer at terminal ileum white colour caseating tissue suggest abdominal tuberculosis supported by history wt loss LOA Raised esr and CRP F/h/o tuberculosis What about USG abdomen to trace paramesenteric lymphnodes To confirm biopsy is advisable Pt needs ATT

In this case - a colonoscopic biopsy needs,to be done to confirm tubercular ulcer & also to rule out malignant ulcer . Once biosy proved - Start ATT - category 1 four drug regimen .for 2 months and then 3 drug regimen for 6 - 7 months. It is always better to Overtreat than undertreat to prevent recurrence

Colonoscopic biopsy to confirm diagnosis of tubercular granuloma with caseous necrosis, epithelioid cells and Langhan's giant cells. A NAAT / PCR test for mycobacterial DNA from biopsy specimen. Once diagnosis is confirmed, plan 4 drug ATT. Make sure patients liver function parameters and uric acid are within permissible limits at baseline. Diagnosis and prognosis have to be properly explained to the patient and the next of kin.

H pylori infection present please use pantop hp kit for 14 days With sucraday O syp With normaxin

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