Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic abdominal pain, typically localized to the right lower quadrant, associated with intermittent diarrhea, low-grade evening fevers, night sweats, and unintentional weight loss. History of constitutional symptoms suggestive of mycobacterial infection. No history of recent travel to endemic areas or known TB exposure. Stool pattern shows increased frequency without frank hematochezia.
Clinical Examination Findings
Physical examination reveals a thin, cachectic patient with temporal wasting. Abdominal exam shows localized tenderness in the right iliac fossa; a palpable, fixed, doughy mass may be present. Bowel sounds are hyperactive. Lymphadenopathy may be noted in the cervical or supraclavicular regions. Chest auscultation is performed to rule out concomitant pulmonary involvement.
Treatment Protocol
Initiate standard anti-tubercular therapy (ATT) regimen: 2 months of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol (HRZE), followed by 4 months of Isoniazid and Rifampicin (HR). Monitor liver function tests (LFTs) and visual acuity periodically. Surgical intervention (e.g., resection or stricturoplasty) is reserved for complications such as intestinal obstruction, perforation, or refractory hemorrhage.