Tuberculosis (TB) – Surgeons perspective!

Introduction 

Tuberculosis ( Koch’s Disease) also commonly known as TB is on of the leading cause of death around the world. This age old disease is till widely prevalent with incidence following down by 1.7 to 2 % per year. The infection generally spreads with air droplet infection through saliva and sputum via the transfer of bacteria mycobacterium tuberculosis. This can affect any organs of the body including lungs, abdomen, skin, bones and Genito-urinary symptoms. 

Risk factors of TB

  1. Old age 
  2. Smoking 
  3. Compromised immunity in case of  associated diabetics, HIV infection, cancers etc 
  4. Intravenous drug abuse 
  5. Occupational hazards for healthcare professionals 

Common symptoms for TB

The symptoms usually depends upon the organ involvement 

The general symptoms associated with TB are weight loss, weakness , decreased appetite, fatigue and anaemia 

  1. Chest TB – chronic cough , blood in sputum , chest pain , Shortness of breath , General symptoms of TB , pus in the chest ( empyema) , collapse of lung 
  2. Abdominal TB – chronic abdominal pain, loose stools , change in bowel habits, decreased appetite along with general symptoms , intestinal obstruction, intestinal perforation , abdominal and perineal sinus and fistulas 
  3. Genitourinary TB-  Pus or blood in urine, flank pain , recurrent urine infections, infections of the kidney , pyonephrosis ( pus in kidney) , nonfunctional kidneys
  4. Bone TB- Bone pain , sinus discharge via skin, fracture of bone 

Investigations for TB 

These are often ignored initially by the patients, we will suggest u to visit your clinician/ surgeon for examination and management 

  1. Routine blood examination, urine tests and sputum test are done
  2. X- ray of the chest . abdomen and bones depending upon the site of disease 
  3. Ultrasonography of chest and abdomen 
  4. Contrast enhanced computerised tomography (CECT) usually some to confirm the diagnosis, extension of the disease and if any surgical complications can be managed accordingly 
  5. Other investigations like Bronchoscopy , CT guided biopsies , advanced blood investigations are often use by clinicians. 

Once the diagnosis is ascertained the medical management with anti-tubercular therapy is started in non complicated case which goes for 6-9 months 

Surgeons prescriptive 

Any complications arising out of TB may require some form of procedure or surgery. Chronic empyema( pus in chest), lung collapse , pleural effusion ( fluid in chest cavity ) can be managed surgically by placement of intercostal tube(ICD) , Video assisted Thoracoscopic surgery( VATS) and endoscopic bronchial lavage.

Abdominal complications include intestinal obstruction, perforation and abdominal sinuses/ fistulas which might require laparoscopic or conventional open surgery depending upon the disease and condition of the patients. Genitourinary and bone TB are dealt with same way by surgeons.  

TB if left untreated can lead to multiple complications and resistance of drugs which might require  long term therapy. It always advised to protect yourself and take medications appropriately as advised. The prognosis of TB in general is very good and majority of the  patients are cured after completing the medications. 

To consult with best team of general and minimal access surgeons available at  The Surgeons House (SHL) in different global locations, please click this link for more details. 

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