Introduction to Liver Tuberculosis

Contents 1 Pinyin 2 English reference 3 Overview 4 Disease name 5 English name 6 Alias ??of liver tuberculosis 7 Classification 8 ICD number 9 Epidemiology 10 Cause 11 Pathogenesis 11.1 Invasion route of Mycobacterium tuberculosis 11.2 Pathological types 12 Liver Clinical manifestations of tuberculosis 13 Complications of liver tuberculosis 14 Laboratory tests 14.1 Blood picture 14.2 Liver function tests 14.3 Serum tests 14.4 Skin tests 14.5 Liver biopsy 14.6 Bacteriological tests 14.7 Polymerase chain reaction (PCR) 15 Auxiliary tests 15.1 X Plain abdominal radiograph 15.2 B-ultrasound 15.3 CT scan 15.4 Abdominal cavity 15.5 Laparotomy 16 Diagnosis 17 Differential diagnosis 18 Treatment of liver tuberculosis 18.1 General treatment 18.2 Medical treatment 18.3 Surgical treatment 19 Prognosis 20 Prevention of liver tuberculosis 20.1 Control the source of infection 20.2 Cut off the transmission route 20.3 Vaccination with BCG vaccine 21 Related medicines attached: 1 Acupoints for treating liver tuberculosis 1 Pinyin

gān jié hé 2 English reference

Hepatic tuberculosis

tuberculosis of the liver 3 Overview

Tuberculosis of the liver is relatively rare. Due to the lack of specific symptoms and signs, the rate of clinical misdiagnosis and mistreatment is high. Due to the improvement of diagnostic level, reports have increased in recent years. According to reports, 79% to 99% of chronic pulmonary tuberculosis and death cases have liver tuberculosis, and autopsies have found that 76% to 100% of patients with miliary tuberculosis are complicated with liver tuberculosis. Liver tuberculosis occurs mostly in young adults, with a male to female ratio of approximately 1:1.2.

The infection route of liver tuberculosis is mostly hematogenous (via hepatic artery or hepatic vein) spread, and a few can spread directly through the lymphatic system or adjacent lesions. The so-called "primary liver tuberculosis" may be that after a small amount of Mycobacterium tuberculosis enters the liver, the extrahepatic primary tuberculosis lesions have been absorbed or fibrosed. When the body's resistance decreases, liver tuberculosis attacks.

The pathology of liver tuberculosis is divided into: ① Miliary (small nodule) type: the most common. Miliary tuberculosis nodules of 0.6 to 3.0 mm are often formed in the liver lobules and portal areas; ② Tuberculoma (large nodule) type: This type is rare, with smaller miliary nodules merging to form solitary or proliferative tuberculosis Nodules may form abscesses; ③ Intrahepatic bile duct type or tuberculous cholangitis: rare, may be caused by caseous material breaking into the intrahepatic bile ducts from the portal system.

Most liver tuberculosis develops slowly. In addition to fever, the most common clinical signs are liver enlargement, medium-sized, blunt edge, and may be tender. Nearly half of the patients have splenomegaly, and jaundice is less common. A few patients may be accompanied by ascites. Complications: It may be complicated by lung abscess, hepatic encephalopathy, gastrointestinal bleeding, etc.

Most liver tuberculosis is part of systemic miliary tuberculosis, which is called secondary liver tuberculosis. Patients mainly show clinical manifestations caused by extrahepatic lung, intestinal and other tuberculosis. Generally, there are no clinical symptoms of liver disease. Intrahepatic tuberculosis can be cured after anti-tuberculosis treatment, but it is difficult to diagnose liver tuberculosis clinically. Primary liver tuberculosis refers to tuberculosis involving the liver and becoming the cause of all clinical manifestations, or when liver tuberculosis occurs, tuberculosis lesions in other parts have healed spontaneously or are very hidden and are not found, and the liver is the only organ where tuberculosis is found. At this time, the patient has systemic manifestations of tuberculosis and/or local manifestations of liver disease, such as fever, chills, night sweats, fatigue, weight loss, nausea, vomiting, abdominal distension, diarrhea, pain and tenderness in the liver area, hepatomegaly, and jaundice, etc. .

Liver tuberculosis is generally treated with medical treatment, but liver tuberculosis should be treated surgically. Prevention and treatment of primary extrahepatic tuberculosis is the key to preventing liver tuberculosis. 4 Disease name

Liver tuberculosis 5 English name

tuberculosis of liver 6 Alias ??of liver tuberculosis

hepatic phthisis; liver tuberculous lesions 7 classification

1. Hepatobiliary Surgery> Hepatobiliary Surgery Infectious Diseases

2. Infectious Medicine> Bacterial Infections> Mycobacterial Infections> Tuberculosis

3. Gastroenterology> Hepatobiliary Diseases> Liver inflammatory diseases and cirrhosis 8 ICD number

A18.8 9 Epidemiology

In recent years, due to the development of anti-tuberculosis drugs, tuberculosis has been gradually controlled, and the incidence of liver tuberculosis has become very high. Low, clinically extremely rare. Most patients are young adults. Domestic statistics show 98 cases of liver tuberculosis, 66.3% are under 37 years old, and the male to female ratio is 1:1.2. A group of foreign autopsies reported that chronic tuberculosis and disseminated miliary tuberculosis were accompanied by liver tuberculosis in 50% to 80% and 100% of cases respectively.

1. Source of infection

In patients with open pulmonary tuberculosis, especially cavitary tuberculosis, bacteria in sputum are an important source of infection for tuberculosis.

2. Route of transmission

Mainly respiratory tract. After the sputum dries, tuberculosis bacteria can float in the air with dust. Infection can occur when a patient coughs or sneezes and contaminates the environment with bacterial droplets. Transmission of tuberculosis bacteria through the gastrointestinal tract is rare and is usually caused by eating or drinking with a patient or drinking unsterilized milk with bacteria. Mycobacterium tuberculosis cannot pass through healthy skin, but it can invade the human body through wounds in the skin and mucous membranes.

3. Susceptibility of the population

The population is generally susceptible and often increases with age. BCG vaccination has a relative immune effect.

4. Epidemic characteristics

In the 19th century, tuberculosis was rampant around the world and was called the "white plague." Since 1945, a variety of anti-tuberculosis drugs have come out one after another, which has gradually reduced the global tuberculosis epidemic, and mankind feels that it is possible to control tuberculosis. However, from the late 1980s to the early 1990s, global tuberculosis rebounded rapidly. The World Health Organization pointed out that 1.7 billion people in the world are currently infected with tuberculosis bacteria, accounting for 1/3 of the world's population. There are currently 20 million tuberculosis patients, about 9 million every year. Among the new cases, 3 million people died from tuberculosis, which has exceeded the combined deaths from AIDS, malaria, diarrhea, and tropical diseases, making it the number one killer and the largest cause of death among infectious diseases. Faced with such a severe situation, the 46th World Health Assembly issued the "Global Tuberculosis Emergency Declaration" in 1993, calling for rapid action to combat the tuberculosis crisis. At present, the epidemic situation of tuberculosis in my country is also quite serious. In the 1990 national sample survey, the prevalence rate of tuberculosis was 523/100,000. It is estimated that there are about 1.5 million infectious tuberculosis patients in the country. Nearly 230,000 people die from tuberculosis every year. There are approximately 330 million people infected with tuberculosis in the country. 34.7% of tuberculosis patients are drug-resistant, making treatment difficult. Moreover, factors such as the spread of AIDS in my country and large-scale population movements have brought new problems to tuberculosis control. 10 Causes

Liver tuberculosis is caused by the spread of various extrahepatic tuberculosis bacteria to the liver. Sometimes the primary extrahepatic focus cannot be detected because the extrahepatic primary focus is small or has healed. According to statistics, it can Only 35% of cases reach the primary tumor.

Mycobacterium tuberculosis belongs to the order Actinomycetes and the genus Mycobacterium in the family Mycobacteriaceae. It is a pathogenic acid-fast bacterium. Mainly divided into human, cow, bird, rat and other types. Those that are pathogenic to humans are mainly human-type bacteria, and bovine-type bacteria are less likely to cause infection. Mycobacterium tuberculosis is slender and curved in shape, with blunt rounded ends, no spores or capsules, and no flagella. It is about 1 to 5 μm long and 0.2 to 0.5 μm wide. In specimens, they appear scattered or in piles or arranged in chains. Mycobacterium tuberculosis is an aerobic bacterium and does not reproduce in the absence of oxygen, but it can still survive for a long time. Under good conditions, it takes about 18 to 24 hours to reproduce for one generation. The lipid component of the bacteria accounts for about 1/4 of its weight, and it is acid-resistant when stained.

Mycobacterium tuberculosis is highly resistant to dryness, strong acid, and strong alkaloids, and can exist in the external environment for a relatively long time. It can survive in sputum for 20 to 30 hours, and in damp places for 6 to 8 months. However, it has very low resistance to heat and humidity and can be killed by boiling it for 5 minutes or directly exposing it to the sun for 2 hours. Ultraviolet disinfection is more effective. Both human and bovine strains of tuberculosis are obligate parasites that use humans and cattle as their natural reservoirs respectively. Both are equally pathogenic to humans, monkeys and guinea pigs. The drug resistance of tuberculosis bacteria can be formed by the development of innate drug-resistant bacteria in the bacterial flora, or it can quickly develop resistance to an anti-tuberculosis drug due to the sole use of the drug in the human body, that is, the acquisition of drug resistance. bacteria. Drug-resistant bacteria can cause difficulties in treatment and affect the efficacy. Long-term exposure of Mycobacterium tuberculosis to streptomycin can also produce dependence, which is the so-called drug dependence, but drug-dependent bacteria are rare in clinical practice. 11 Pathogenesis

The liver has rich blood supply and lymph, and is the most vulnerable site for hematogenous disseminated tuberculosis in the body. Generally, Mycobacterium tuberculosis that enters the human body can reach the liver. However, the liver has strong regeneration and repair capabilities and has a rich mononuclear phagocyte system. Bile can also inhibit the growth of tuberculosis bacteria. Therefore, not all tuberculosis bacteria that invade the liver can form lesions. Liver tuberculosis is more likely to occur only when the body's immune function is low or when a large number of tuberculosis bacteria invade the liver or when there are certain lesions in the liver itself, such as fatty liver, liver fibrosis, cirrhosis or drug damage.

In recent years, it has been found that the incidence of liver tuberculosis in people infected with human immunodeficiency virus (HIV) or their patients has increased significantly, suggesting that cellular immunity plays an important role in the occurrence and development of liver tuberculosis. 11.1 Invasion pathways of Mycobacterium tuberculosis

The pathways by which Mycobacterium tuberculosis invades the liver are:

① Hepatic artery: It is the main pathway that causes liver tuberculosis. Systemic hematogenous tuberculosis, or active tuberculosis lesions in any part of the body, due to reduced immunity or due to some local factors, the tuberculosis lesions rupture, and the tuberculosis bacilli enter the blood circulation and enter the liver through the hepatic artery.

②Portal vein: A small number of liver tuberculosis can be infected through the portal vein. Mycobacterium tuberculosis in organs or tissues originating from the portal venous system, such as intestinal tuberculosis or mesenteric lymph node tuberculosis lesions, invades the liver through the portal vein.

③Umbilical vein: Mycobacterium tuberculosis in placental tuberculosis lesions during fetal period enters the fetus through the umbilical vein and causes congenital liver tuberculosis.

④ Lymphatic system: Intrahepatic lymphatic vessels are directly connected to the abdominal lymph plexus and retroperitoneal lymph nodes, so intra-abdominal tuberculosis can enter the liver via lymph to form an infection focus.

⑤Direct spread: Tuberculosis lesions in organs and tissues adjacent to the liver can directly invade the liver. 11.2 Pathological types

The basic pathological change of liver tuberculosis is granuloma. Different pathological types can develop due to differences in factors such as the number and location of the invading tuberculosis bacteria and the body's immune function status. Generally it can be divided into:

①Miliary type: the most common. It is part of systemic hematogenous disseminated miliary tuberculosis. The lesions are millimeter-sized to 2cm in size, hard in texture, white or off-white with multiple small nodules, and are widely distributed throughout the liver. This type of disease is serious and clinical diagnosis is difficult. It is mostly discovered during autopsy or laparotomy.

②Nodular type: rare. The lesions are relatively localized, forming single or multiple nodules that are more than 2 to 3 cm in size, hard, gray-white, or even fuse into clumps, resembling tumors, and are also called tuberculomas.

③Abscess type: The center of the tuberculosis lesion becomes necrotic and forms white or yellow-white cheese-like pus, which can be single or multiple. The abscess cavity is mostly single room, and multi-room is rare.

④ Bile duct type: Liver tuberculosis lesions involve the bile duct or abscess breaks into the bile duct to form bile duct tuberculosis lesions, which are manifested as bile duct wall thickening, ulceration or stenosis. This type is rare.

⑤ Liver serosal type: manifests as miliary tuberculosis lesions in the liver capsule or capsule hyperplasia and hypertrophy, forming the so-called "sugar-coated liver". Relatively rare. 12 Clinical manifestations of liver tuberculosis

Most liver tuberculosis has a slow onset. In addition to fever, the most common clinical signs are liver enlargement, medium-sized, blunt edge, and may be tender. Nearly half of the patients have splenomegaly, and jaundice is less common. A small number of patients with liver tuberculosis may be accompanied by ascites.

The main symptoms of liver tuberculosis include fever, loss of appetite, fatigue, pain in the liver area or right upper quadrant, and hepatomegaly.

Fever mostly occurs in the afternoon, sometimes accompanied by chills and night sweats; there are low-grade fever and flaccid fever, and high fever can reach 39-41°C. 91.3% of people have fever symptoms. Those with tuberculosis or a clear history of tuberculosis have long-term recurrence. Those who have fever and exclude other causes often have the possibility of liver tuberculosis.

Hepatomegaly is the main sign of liver tuberculosis. More than half of the patients have tenderness, hard liver, and nodular masses; about 15% of patients may develop mild jaundice due to nodules compressing the hepatic bile duct, and 10% of cases had ascites. 13 Complications of liver tuberculosis

1. Jaundice

Generally mild or moderate, mostly persistent, and a few may fluctuate. It is often associated with acute fulminant type. The causes are:

(1) Tuberculous lymph nodes compress the extrahepatic bile duct.

(2) Intrahepatic tuberculous granuloma destroys the liver parenchyma or ruptures into the bile duct.

(3) The small intrahepatic bile ducts are blocked.

(4) Toxic liver cell damage, fatty liver, etc. Specific to a given patient, it may be due to several factors.

Chronic disseminated tuberculosis and the end-stage tuberculosis are accompanied by liver tuberculosis, and 80% of them develop jaundice, indicating that jaundice indicates a serious condition.

2. Hepatomegaly

The vast majority of patients with liver tuberculosis have hepatomegaly (76% to 95%), among which those 2 to 6cm below the ribs are more common (42 %). The surface of the liver is mostly medium hard and generally smooth, with a few having obvious nodules. There may be tenderness in the liver, and sometimes tuberculosis lesions involve the liver capsule and friction sounds may occur. If an intrahepatic tuberculosis abscess forms, liver pain and tenderness will be more obvious; when the abscess ruptures, severe abdominal pain, shock and peritonitis are often present. Causes of hepatomegaly include tuberculous liver abscess, tuberculoma, tuberculous granuloma, non-specific reactive hepatitis, fatty liver, amyloidosis, etc.

3. Splenomegaly

It is seen in about half of liver tuberculosis cases. The enlargement is relatively obvious, mostly 0.5 to 9cm below the ribs, and can also exceed the umbilicus. Splenomegaly associated with liver tuberculosis generally indicates splenic tuberculosis. It is mainly due to the infiltration of tuberculous granuloma and the proliferation of splenic medullary reticular cells. Splenomegaly is often accompanied by hypersplenism, and the three formed blood components are reduced to varying degrees.

4. Ascites and abdominal mass

Mainly caused by tuberculous peritonitis and lymph node tuberculosis.

In addition, liver tuberculosis can also be complicated by lung abscess, hepatic encephalopathy, gastrointestinal bleeding, etc. 14 Laboratory tests 14.1 Blood picture

The total number of white blood cells is normal or low, and patients with splenomegaly may show pancytopenia. A small number of patients with liver tuberculosis may have elevated levels and even develop leukemia-like reactions. More than 80% of patients have anemia, and the erythrocyte sedimentation rate is often accelerated. 14.2 Liver function test

About half of liver tuberculosis cases have liver function damage, with elevated ALT, ALP and bilirubin, and possibly decreased albumin and increased globulin. The A/G ratio is inverted, and phosphatase is increased in patients with jaundice. 14.3 Serum examination

Positive results of serum anti-tuberculosis purified protein derivative (anti-PPD) IgG antibody determination can assist in the diagnosis of liver tuberculosis. 14.4 Skin test

Including OT (old tuberculin) or PPD (purified protein derivative) skin test, continuous observation for 12 hours, positive ones can be used as a reference for liver tuberculosis diagnosis. 14.5 Liver biopsy

It has great diagnostic value for diffuse or miliary lesions. 14.6 Bacteriological examination

Acid-fast staining of liver tissue sections obtained through puncture or surgery is used to search for Mycobacterium tuberculosis. The positive rate of bacteria in miliary lesions can reach 60%. 14.7 Polymerase chain reaction (PCR)

In vitro amplification of Mycobacterium tuberculosis DNA: PCR technology has been used for the diagnosis of tuberculosis. In addition to being used to detect Mycobacterium tuberculosis DNA in body fluids and discharges, it is also used to detect Mycobacterium tuberculosis DNA in biopsy pathological specimens. This technology is still under development and is expected to improve the diagnosis of liver tuberculosis. 15 Auxiliary examination 15.1 Plain abdominal X-ray film

Intrahepatic calcifications may be found. It has been reported that 48.7% of patients with liver tuberculosis have intrahepatic calcifications.

In some cases of liver tuberculosis, the right side of the diaphragm may be elevated and its movement may be weakened. 15.2 B-ultrasound

It can detect hepatomegaly and larger lesions in the liver, and can also be used for lesion puncture examination under its guidance. 15.3 CT scan

Can detect intrahepatic lesions. 15.4 Abdominal cavity

Examination can reveal yellowish-white punctate or flaky lesions on the liver surface, and the lesions can be punctured under direct vision for further examination such as pathology and bacteriology. 15.5 Exploratory laparotomy

In some difficult cases of liver tuberculosis, a clear diagnosis can be obtained through surgery if necessary. 16 Diagnosis

The clinical manifestations of liver tuberculosis lack specificity, making diagnosis difficult. For young adults with unexplained fever, accompanied by liver enlargement, distending and pain in the liver area or upper abdomen, liver function damage, and anemia, this disease should be suspected. White blood cells may be reduced or normal, and the erythrocyte sedimentation rate may be increased. The toxin test can be positive, but in severe cases it can be negative. Nearly half of the patients can be diagnosed clearly through liver biopsy. If necessary, exploratory laparotomy or early experimental treatment with anti-tuberculosis drugs can be performed. 17 Differential diagnosis

Liver tuberculosis needs to be differentiated from hepatitis, typhoid fever, malaria, brucellosis, chronic schistosomiasis, leptospirosis, etc.

① Localized liver tuberculosis is sometimes difficult to distinguish from liver cancer, and miliary liver tuberculosis is sometimes easily confused with diffuse liver cancer, but the latter is serious, develops rapidly, is AFP positive, and combined with a history of chronic liver disease etc., can generally be identified.

② Abscess formation from liver tuberculosis should be differentiated from amebic or bacterial liver abscess. Bacterial liver abscesses are mostly secondary to biliary tract infection, with severe symptoms of systemic poisoning, including chills and high fever, while amebic liver abscesses often have a history of pus and blood in the stool. The abscesses are generally larger and the pus is chocolate-colored, so it is generally not difficult to identify.

③ For cases with jaundice, be careful not to misdiagnose them as viral hepatitis, cirrhosis, leptospirosis, sepsis, etc. Especially when the patient has a history of tuberculosis or is getting worse after treatment is ineffective, he should be vigilant. possible tuberculosis and undergo relevant examinations.

④ Hepatosplenomegaly, high fever, jaundice, anemia, and cachexia should be differentiated from lymphoma, acute leukemia, and malignant reticulocytosis. Bone marrow imaging and lymph node biopsy can be checked. 18 Treatment of liver tuberculosis

Liver tuberculosis is generally treated with medical treatment, but liver tuberculosis should be treated surgically. 18.1 General treatment

Take appropriate rest and strengthen nutrition; support treatment should be strengthened for those who are weak or seriously ill. 18.2 Medical treatment

The medication regimen for liver tuberculosis can be based on that of pulmonary tuberculosis, and the course of treatment should be extended appropriately. When patients with liver tuberculosis have liver function abnormalities such as elevated ALT, it is not a contraindication to anti-tuberculosis treatment, but an indication. ALT may fluctuate slightly during the course of treatment, but it will soon return to normal.

Early application of anti-tuberculosis drugs, commonly used are isoniazid, streptomycin, para-aminosalicylic acid (PAS), rifampicin and ethambutol. The course of treatment for isoniazid is generally 2 years, streptomycin for 3 to 6 months, and PAS can be used for more than half a year based on the patient's response. At the same time, nutrition and systemic supportive treatment should be strengthened.

Anti-tuberculosis chemical drug treatment should follow the principles of early, combined, appropriate, regular and full-course medication. The method is the same as for hematogenous disseminated tuberculosis, and short-course chemotherapy under supervision proposed by WHO is used. The specific plan can be 2SRHZ/4R3H3, 2ERHZ/4R2H2, etc., with a treatment course of 6 to 9 months (S is streptomycin, H is isoniazid, R is rifampicin, Z is pyrazinamide, and E is ethambutol , the number in front of the drug represents the number of months, and the number in the lower right corner after the drug represents the number of doses per week). If high fever occurs in the early stage, prednisone 10 mg can be added to the treatment with effective anti-tuberculosis drugs, 3 times/day. The dose can be reduced as soon as the fever subsides. Drug-resistant tuberculosis, especially multidrug-resistant tuberculosis (MDRTB), is the most difficult problem currently faced in clinical tuberculosis prevention and treatment. For the control of MDRTB, the most important measure is to prevent its occurrence. For MDRTB that has already appeared, effective treatment should be carried out as soon as possible. The plan should include at least 4 drugs, and 6 to 7 drugs if necessary. The decision should be based on the scope of the disease, drug efficacy, drug sensitivity test and reference to the previous drug history, and strive to achieve individuality. change.

While taking active systemic anti-tuberculosis treatment, repeated puncture and extraction of pus from the abscess, flushing the abscess cavity with 0.5% SM, and then injecting 50 to 100 mg of INH can speed up the healing of the abscess. 18.3 Surgical treatment

For patients with large tuberculous liver abscesses, surgical drainage or liver lobectomy can be considered while receiving effective anti-tuberculous drug treatment.

For patients with liver tuberculosis limited to one lobe of the liver, if there is no active extrahepatic tuberculosis and the liver function can tolerate surgery, liver lobectomy can be performed after a period of anti-tuberculosis drug treatment. Anti-tuberculosis treatment should be continued to prevent the spread of tuberculosis bacteria.

The indications for surgical treatment are:

(1) Large solitary tuberculoma, tuberculosis nodules fused into a mass or caseous liver abscess.

(2) Patients with jaundice caused by lesions compressing the porta hepatis.

(3) Those complicated by portal hypertension, esophageal variceal rupture and bleeding, or splenic tuberculosis or hypersplenism.

(4) Those complicated by massive biliary bleeding.

(5) Malignant disease cannot be ruled out if the diagnosis is unclear. 19 Prognosis

Because the liver has abundant mononuclear macrophages, rich reticuloendothelial tissue and strong reactivity, it has strong regeneration and defense capabilities, and can form a barrier in time, so the liver Tuberculosis has a tendency to heal on its own. However, once a patient shows symptoms of active liver tuberculosis such as high fever, chills, and hepatomegaly, it is difficult to recover on his own; if no specific treatment is given in time, the disease will generally deteriorate rapidly and die within weeks or months. Anti-tuberculosis drug treatment can be effective immediately, and even very severe cases of liver tuberculosis can often be cured.

The prognosis of liver tuberculosis depends to a large extent on the correct clinical diagnosis, or the sooner or later the diagnosis is made. If diagnosed early and given timely anti-tuberculosis treatment, even severe cases can be cured. Miliary liver tuberculosis usually recovers in 6 to 8 months with effective anti-tuberculosis treatment. Other types of liver tuberculosis may take slightly longer to recover from. Death is often caused by misdiagnosis or too late diagnosis, which results in loss of treatment opportunities, worsening of the condition, and poor prognosis. Severe liver failure caused by complications of fatty liver can be the cause of death. Jaundice indicates severe liver damage and a poor prognosis. 20 Prevention of Liver Tuberculosis 20.1 Control of the Source of Infection

The discovery and management of the source of infection is an important part of the prevention and control of tuberculosis. Early detection and early treatment should be achieved. To this end, regular collective lung health examinations should be carried out. Implement a registration management system. 20.2 Cut off the transmission route

First, active pulmonary tuberculosis should be cured actively, early and completely, and the sputum bacteria should be turned negative.

The main methods for managing and processing patients' sputum are: carrying out mass health campaigns, widely publicizing anti-tuberculosis knowledge, developing good hygiene habits, and not spitting everywhere. Tuberculosis patients should spit out their phlegm. Put it on paper and burn it, or add 2% cresol soap or 1% formaldehyde solution into a sputum cup (it can be sterilized in about 2 hours), and expose the contact object directly to the sun (it can be sterilized in a few hours).

The tableware used by patients with active tuberculosis should be used separately and boiled and disinfected regularly to prevent cross-infection.

Milk must be pasteurized (56℃×30min) or boiled for drinking. Do not drink raw milk.

Strengthen personal hygiene, dry clothes, bedding and other daily necessities frequently to kill contaminated Mycobacterium tuberculosis.

Strengthen physical exercise and improve the body’s disease resistance. Human body surface area calculator BMI index calculation and evaluation Female safe period calculator Pregnancy date calculator Normal weight gain during pregnancy Safety classification of medication during pregnancy (FDA) Five elements and eight characters Adult blood pressure evaluation Body temperature level evaluation Diabetes diet recommendations Clinical biochemistry common units conversion basal metabolic rate Calculate sodium supplementation calculator Iron supplementation calculator Commonly used Latin abbreviations for prescription Quick check Common symbols for pharmacokinetics Quick check Effective plasma osmolality calculator Ethanol intake calculator

Medical encyclopedia, calculate now! 20.3 Vaccination with BCG vaccine

Vaccination with BCG vaccine can enhance the body’s resistance to tuberculosis bacteria and help prevent the occurrence of tuberculosis. At present, our country stipulates that the BCG vaccine should be vaccinated after birth, and those who are negative should be vaccinated additionally. When ethnic minorities and border residents enter inland cities, or when new soldiers join the army, they must take a tuberculin test, and those who show a negative result will be vaccinated with the BCG vaccine.

21 Related Drugs

Isoniazid, Streptomycin, Salicylic Acid, Rifampicin, and Ethambutol are used to treat liver tuberculosis at the acupoint Jianzhongwaishu

Strong pain or dizziness , if the chest is knotted and the heart is hard, stab Taiyang Feishu and Ganshu. "A Thousand Gold Prescriptions for Emergency": If you are upset and have qi, moxibustion Feishu, acupuncture five points... Tianhui

Qi widens the chest, clears away heat and dissipates stagnation. Tianchi point is the meeting point of the pericardium, triple burner, gallbladder and liver meridians. It has the effect of widening the chest, regulating qi, calming the heart and calming the mind. Mainly used to treat heartache,... Zhongfu

The spasm effect can improve pulmonary ventilation and relieve asthma. Improve the blood circulation of the liver: Using intravascular injection of radionuclide, it was found that during acupuncture... the head was flushed

and the patient was not allowed to lie down. "Huangdi Neijing Lingshu·Cold and Heat Diseases": Severe internal reversal, liver and lungs fighting each other, blood overflowing the nose and mouth, taking away the heaven. "Acupuncture and Moxibustion Jia and B Jing": Coughing up gas... Tianwuhui