Cirrhotic tuberculosis - Causes, Symptoms, Diagnosis and Treatment
Cirrhotic tuberculosis - The final stage of tubercular process, which is typical for pnevmotsirroza predominance of specific lesions of the lung tissue. Cirrhotic transformation of light is accompanied by shortness of breath, cough with sputum, hemoptysis, respiratory and cardiac failure. Cirrhotic tuberculosis is diagnosed based rentgenosemiotiki, functional data, the results of laboratory and bronchoscopy examinations. Depending on the current phase of cirrhotic lung tuberculosis is assigned to antibiotic therapy, chemotherapy, specific correction of cardiopulmonary diseases. With limited pnevmotsirroze performed surgery.
Cirrhotic tuberculosis
pulmonary tuberculosis - a morphological variant of the tuberculosis infection, which is characterized by coarse scarring in the lung parenchyma and pleura, combined with minimal activity specific inflammation. Developed in the outcome of other forms of pulmonary tuberculosis; according to the observations of different authors, occurs with a frequency of 0.1-8%. For the formation of cirrhotic pulmonary tuberculosis requires long-term, calculated in years. In this form of tuberculosis process morphological rearrangement of the lung tissue is irreversible, and in severe cases may lead to death. Cirrhotic patients with pulmonary tuberculosis are subject to peer monitoring by the experts in the field of tuberculosis and pulmonology.
tuberculosis, and rarely occurs in the primary process. In the majority of cases the rough cirrhotic parenchymal infiltrative formed on the background, fibrocavernous, disseminated pulmonary tuberculosis and pleurisy of tuberculous etiology.
When infiltrative pulmonary tuberculosis pathologic basis for the proliferation of connective tissue becomes inflammatory infiltrate in which there is loss of fibrin collagenization alveolar membranes, fibrosis areas of atelectasis. When fibro-cavernous tuberculosis coarse fibrous transformation affects the cavity walls and perikavitarnuyu zone. If involution occurs disseminated tuberculosis connective transformation of lesions; cirrhotic process is usually diffuse bilateral nature. In all these cases, formed the so-called pnevmogenny cirrhosis of the lung.
In patients who underwent tuberculous pleurisy, treatment with artificial pneumothorax or surgical thoracoplasty develops cirrhosis plevrogenny: with connective tissue grows into the pulmonary parenchyma of pleural thickening.
Cirrhotic pulmonary tuberculosis may be complicated by tuberculosis VGLU, primary tuberculosis complex, tuberculosis bronchi. When these forms of pulmonary fibrosis is caused by obstruction of the bronchus in atelektaticheskom site (usually in reed segments of the left lung, upper and middle lobe of the right lung). Such a mechanism of pathogenesis is called bronchogenic cirrhosis.
Substitution of significant portions of the parenchyma by connective tissue, bronchial distortion, obliteration of blood vessels, limiting the mobility of the lung due to the pleural Mooring and emphysema leads to a lack of gas exchange and blood circulation, the formation of pulmonary heart. Against the background of scar tissue are determined encysted foci of caseation, as well as areas of productive inflammation. When bronchogenic embodiment cirrhosis specific inflammation is usually localized in the lymph nodes and bronchial tubes.
Cirrhotic tuberculosis is diagnosed more often in older patients, as the restructuring of the lung tissue with age occurs more actively. In children, a triggering factor for the development of timely pnevmotsirroza becomes unrecognized primary tuberculosis complicated by lung atelectasis. Taking into account the area affected distinguish limited (segmental, lobar) and diffuse; single- and double-sided cirrhotic pulmonary tuberculosis.
purulent bronchitis - worried cough with purulent sputum, shortness of breath often wheeze type, periodically repeated hemoptysis. The body temperature rises to 38 ° C and above, there is intoxication syndrome, there is a lot of wet wheezing. The acute phase of tuberculous process join batsillovydenie and symptoms of tuberculosis intoxication. In total unilateral or bilateral cirrhotic pulmonary tuberculosis in the foreground shortness of breath, tachycardia, cyanosis.
Hypertension in the pulmonary circulation leads to the appearance of pulmonary hemorrhage. Aspiration of blood can be accompanied by the development of aspiration pneumonia. Gradually intensified the phenomenon of heart failure: there are peripheral edema, hepatomegaly, ascites. During prolonged purulent intoxication develops visceral amyloidosis, chronic renal failure. Causes of death in patients with cirrhotic lung tuberculosis are massive bleeding, cardiopulmonary failure, and amyloidosis.
pulmonologist or TB specialist. On examination of patients draws attention to chest deformity (flattening it, beveled edges, narrowing the intercostal spaces, emphysematous expansion of the lower divisions). For percussion over the area defined by shortening pnevmotsirroza pulmonary sound. Breathing hard, sometimes bronchial constantly listened dry and crackles.
The basic diagnostic information about the specifics of the disease gives the X-ray light. Radiographs revealed darkening of the affected lobe or segments of the diseased portion of the lung is reduced in size. Against the backdrop of darkening can be allocated more highlights (bronchiectasis, cavities). Thickened pleura, mediastinum shadow biased towards defeat. Especially well-described changes are visible in the tomograms. Previously, to detect changes in the bronchial tubes in the area cirrhosis bronchography widely used, but currently it successfully replaces the CT scan of the lungs.
MBT in sputum revealed impermanent, often with acute exacerbation of tuberculosis. When sputum bakposeve mainly emit nonspecific microflora confirming the activity of the inflammatory process. Tuberculin diagnosis in cirrhotic pulmonary tuberculosis does not play a leading role. Bronchoscopy helps to detect when postinflammatory scar stenosis of the bronchi, purulent endobronchitis. When conducting spirometry is defined by a sharp decline in respiratory volumes, mainly ZHЁL. Cirrhotic tuberculosis differentiate with COPD, pulmonary sarcoidosis, pneumoconiosis, fibrosing alveolitis.
inhalation. The choice tuberkulostaticheskoy regimens decided individually. To reduce the symptoms of chronic pulmonary heart uses oxygen therapy, appointed antioxidants, antiplatelet agents, vozodilatatory.
It has a limited unilateral cirrhosis is easy indication for lung resection (segmentectomy, lobectomy). This can prevent the occurrence and progression of complications of cirrhosis: pulmonary hemorrhage, cardiopulmonary failure, amyloidosis, which become a cause of death, at least 3% of patients. Prevention of pulmonary tuberculosis cirrhotic reduced to timely treatment of its earlier forms.