Lecture topic:

"PERIPHERAL AND MESENTERIC LYMPH NODE TUBERCULOSIS.

CLINIC, DIAGNOSIS, DIFFERENTIAL

DIAGNOSIS, OUTCOMES."

Lecturer: MD Babayeva I.Y.

According to the Evolutionary-Patogenetic Classification, there are four stages of peripheral lymph node tuberculosis:

1.Stage I - initial proliferation. In the infiltrative form, the enlargement of the lymph node is due to few tuberculous granulomas and nonspecific periadenitis.

2.Stage II is caseous.

3.Stage III is abscessed.

4.Stage IV - fistulous (ulcerative).

FORMS OF TUBERCULOSIS OF PERIPHERAL LYMPH NODES:

1.The caseous-necrotic form is characterized by almost total necrosis of the lymph node and numerous confluent tuberculous foci, often with suppuration and formation of fistulas.

2.The indurative form is typified by a scar- like thickening of the affected lymph nodes and surrounding tissues.

CLINICAL COURSE OF peripheral lymph node tuberculosis:

1.Usually detected during examination due to complaints of enlarged lymph nodes, their painfulness, gradually increasing symptoms of intoxication.

2.Conversion of tubercular tests may be a reason for examination for children.

3.Infiltrative and caseous forms are accompanied by an increase in body temperature and other symptoms of intoxication.

4.In the early stages of the disease, lymph nodes on palpation are elastic, mobile, not adherent, slightly painful, no more than 1 cm in diameter.

5.As the tuberculosis progresses, the lymph nodes increase to 2-4 cm in diameter and periadenitis develops. The skin above the lymph node conglomerate becomes red, fluctuates, and then a fistula develops with a discharge in the form of caseous or pus-like masses. With a prolonged course, scar tissue develops in and around the lymph nodes. Rough retracted scars form on the skin in the affected area.

6.Hemogram changes mainly reflect the presence and degree of inflammatory process (neutrophilic leukocytosis, monocytosis, lymphopenia; hypochromic anemia in case of caseous-necrotic course).

Сomplications of tuberculosis of peripheral lymph nodes

1.Formation of abscesses and fistulas

(29.7%).

2.Bleeding.

3.Generalization of the process.

TUBERCULOUS MESADENITIS

– IS A TUBERCULOUS INVOLVEMENT OF THE MESENTERIC LYMPH NODES, THE MOST COMMON FORM OF ABDOMINAL TUBERCULOSIS.

The main route of entry of infection into the mesenteric lymph nodes is lymphogenic.

In the pathogenesis of tuberculous mesadenitis, the alimentary route of infection with Mycobacterium tuberculosis with further lymphogenic advancement of the infection to the mesenteric nodes cannot be excluded. The tuberculosis process is often not limited to mesenteric nodes, but spreads to other groups of lymph nodes of the abdomen, peritoneum, intestines, pelvic organs.

MORPHOLOGICAL FORMS OF TUBERCULOUS MESADENITIS:

1.Infiltrative - hyperplasia of lymphoid elements with few tubercular foci are determined.

2.Fibrous - lumpy rashes among the fibrous tissue.

3.Fibrotic-caseous - predominantly caseous-necrotic masses with a fibrous capsule and fibrosis of the surrounding tissues.

THE CLINICAL COURSE OF

TUBERCULOUS MESADENITIS:

1.It is characterized by the absence of pathognomonic symptoms.

2.Can be acute and chronic, with remissions and exacerbations.

3.In the acute course: abdominal pain of different localization, but most often in the navel, left subcostal and right iliac region. The pain may be intense and resemble the picture of an acute abdomen.

4.The abdomen is usually evenly swollen, not tense, and the anterior abdominal wall is involved in breathing.