Pancreatic Tuberculosis

Topic Name Introduction Clinical Features Diagnosis Treatment Prognosis and Follow-up

Pancreatic Tuberculosis in Children

Key Points

• Rare form of abdominal tuberculosis
• Can mimic pancreatic malignancy
• More prevalent in immunocompromised children
• Often presents with non-specific symptoms
• Diagnostic challenges due to anatomical location

Pathophysiology

• Routes of Infection:
  • Hematogenous spread from pulmonary TB
  • Direct spread from adjacent organs
  • Lymphatic spread
  • Reactivation of dormant foci
• Pathological Changes:
  • Granulomatous inflammation
  • Caseating necrosis
  • Fibrosis and calcification
  • Pancreatic duct involvement

Risk Factors

• HIV infection
• Malnutrition
• Previous TB infection
• Endemic area residence
• Close contact with TB patients
• Immunosuppressive therapy

Clinical Manifestations

Common Symptoms

• Constitutional Symptoms:
  • Fever
  • Weight loss
  • Night sweats
  • Fatigue
  • Anorexia
• Abdominal Symptoms:
  • Abdominal pain (especially epigastric)
  • Jaundice
  • Vomiting
  • Early satiety
  • Abdominal distention

Physical Findings

• General Examination:
  • Cachexia
  • Pallor
  • Lymphadenopathy
• Abdominal Examination:
  • Epigastric mass
  • Hepatomegaly
  • Ascites
  • Abdominal tenderness

Complications

• Pancreatic:
  • Acute pancreatitis
  • Pancreatic abscess
  • Pancreatic fistula
  • Diabetes mellitus
• Biliary:
  • Obstructive jaundice
  • Biliary strictures
  • Cholangitis

Diagnostic Approach

Laboratory Studies

• Basic Investigations:
  • Complete blood count
  • ESR and CRP
  • Liver function tests
  • Serum amylase and lipase
  • Blood glucose levels
• TB-Specific Tests:
  • Tuberculin skin test
  • Interferon-gamma release assay
  • PCR for MTB in tissue samples
  • Culture studies

Imaging Studies

• Ultrasonography:
  • Pancreatic mass characteristics
  • Lymphadenopathy
  • Associated findings
• CT Findings:
  • Hypodense lesions
  • Ring-enhancing lesions
  • Calcifications
  • Pancreatic enlargement
• MRI Features:
  • T1 and T2 signal characteristics
  • Enhancement patterns
  • Ductal involvement

Diagnostic Procedures

• EUS-guided FNA:
  • Tissue sampling
  • Cytological examination
  • Culture studies
• Laparoscopic biopsy
• Open surgical biopsy

Management Strategy

Medical Management

• Anti-tubercular Therapy:
  • Initial Phase (2-3 months):
    • Isoniazid
    • Rifampicin
    • Pyrazinamide
    • Ethambutol
  • Continuation Phase (4-7 months):
    • Isoniazid
    • Rifampicin

Supportive Care

• Nutritional support
• Pain management
• Management of complications
• Pancreatic enzyme supplementation if needed

Surgical Management

• Indications:
  • Diagnostic uncertainty
  • Large abscess formation
  • Biliary or duodenal obstruction
  • Non-resolving symptoms
• Procedures:
  • Drainage of collections
  • Bypass procedures
  • Resection in selected cases

Prognosis and Follow-up

Monitoring

• Clinical Response:
  • Symptom resolution
  • Weight gain
  • Activity level
• Laboratory Monitoring:
  • Inflammatory markers
  • Liver function
  • Pancreatic function
  • Blood glucose levels
• Imaging Follow-up:
  • Serial ultrasonography
  • CT/MRI as needed

Expected Outcomes

• Good prognosis with early diagnosis and treatment
• Resolution of pancreatic masses
• Potential complications requiring long-term follow-up
• Risk of endocrine/exocrine insufficiency

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.