1229 Exam 7: Gastroenteritis Flashcards
What is the patho of Gastroenteritis?
An increas in frequency and water content of stools or vomiting, as a result of inflammation of the mucous membranes of the stomach and intestinal tract. Can be viral or bacterial in orgin. All organisms that are implicated in gastroenteritis cause diarrhea!
What does gastroenteritis effect?
stomach and intestines
What does enteritis effect?
small intestine
What does colitis effect?
colon
what does enterocolitis effect?
intestines and colon
Acute diarrhea
leading cause of illness <14 days.
Chronic Diarrhea
last more than 14 days
Intractable Diarrhea of Infancy
intractable=incurable or resistant to treatment
first few months of life. >2weeks
Chronic Nonspecific Diarrhea (CNSD)
irritable colon 6-54 months of age.
loose stool with undigested food.
>2 weeks duration
Causes of viral acute diarrhea
rotavoris
norwalk-like organism
Causes of bacterial acute diarrhea
e coli salmonella shigell yersina vibrio staph campylobacter clostridium c-diff c-perf c-botulinum
Cases of Parasitic acute diarrhea
giardiasis
threadworm
whipworm
What does it look like?
frequent loose stools
dehydration
electrolyte disturbances
malnutrition
How is it diagnosed?
History and physical
laboratory evaluation
urine and blood testing
stool cultures
Complication of gastroenteritis?
Dehydration.
when total output of fluids exceeds the total intake
Types of dehydration:
-isotonic (salt and water lost in equal amounts.) -hypotonic (loose more electrolytes) -hypertonic (loose more water)
Isotonic Dehydration:
salt and water lost in equal amounts primary form in children loss from ECF (extracellular fluid) reduce plasma volume effects skin muscles and kidneys can lead to shock sodium levels will remain within norm limits
Hypotonic Dehydration:
loose more electrolytes than water serum ishypotonic ICF more concentrated than ECF water moved to higher concentration (ICF) this further dehydrates ECF shock is a frequent finding physical symptoms more severe with smaller fluid loses serum sodium is less than 130*****
Hypertonic Dehydration:
loose more water than electrolytes most dangerous requires more specific fluid replacement happens in high protein NG feedings happens with high solute fluids fluid shift from less concentration ICF to ECF serum sodium is greater than 150*** shock is less apparent neuro disturbances cerebral changes are serious and may result in permanent damage
S&S of dehydration
weight loss thirst absence of tears, sunken look to eyes fontanels sunken tachycardia BP decreased increased H&H decrease in skin turgor irritable to lethargy urine specific gravity >1.020--anuria
Treatment goals for dehydration:
assessment (fluid/electrolyte imbalance)
rehydration
maintenance fluid therapy
reintroduction of an adequate diet
Fluid/Electrolyte Replacement:
ORT: oral rehydration therapy ORS: Oral rehydration solutions Maintenace fluid therapy Early reintroduction of nutrients intravenous fluid replacement--- only when oral is not possible.
What is Giardiasis?
Giardia lamblia
most common intestinal parasitic pathogen in US
cysts can survive for months in environment
mode of transmission: person to person, water, food, and animals
What are common symptoms of Giardiasis?
abdominal cramps
diarrhea
anorexia
FTT
What is giardiasis caused by?
the protozoan Giardia lamblia
How do you diagnose Giardiasis?
stool specimen direct aspiration of duodenal fluid biopsy EIA enzyme immunoassay of specimens String test.
Medications for Giardiasis:
Flagyl (metronidazole) -tast bitter, n/v
Tindamax (tinidazole) -taste bitter, n/v 80-100% cure rate with single dose
Albendazole–fewer side effects
Alinia (nitazoxanide) –no bitter taste, give with food to prevent N&V
What am I gonna teach my pt?
education to prevent
sanitation practices
medication education
Helminthic Infestations
Round worms(nematodes) 1. Ascaris Lumbricoides (Most common roundworm) 2. Necaator Americanus (Hookworm) 3. Trichuris truchiura (Whipworm) 4. Strongyloides Stercoralis (threadworm) 5. Enterobius vermicularis (pinworm)
Ascaris lumbricoides
Most common roundworm
Ascar if she is gonna be round.
Necaror americanus
Hookworm
Americans are hooked
Trichuris trichiura
Whipworm
I can pop a mean trich whip
Strongyloids stercoralis
threadworm
This one has strong threads
Enterobius vermicularis (pinworm)
don’t go “en the pin”
Enterobiasis (Pinworms)
What is it???
- Enterobius vermicularis (nematode, human pinworm)
- Most common helminth infection (40k Infected)
- Eggs are ingested/inhaled then hatch in upper intestine.
-Adult females migrate to anus and lay
eggs
-Eggs can live in the environment for 2-3 weeks.
Enterobiasis (Pinworms)
What does it look like???
- Most common symptom `intense itching at the anal area `Bed-wetting `Irritable, restlessnes, poor sleep `perianal dermatitis, vaginal/urethral infection
Enterobiasis (Pinworms)
How is it diagnosed???
Tape test (see diagram)
Enterobiasis (Pinworms)
How is it treated???
Medications:
- Mebendazole (vermox) choice (not under 2 years)
- Pyrantel pamoate (antiminth)
- Piperazine phospate (pripsen)
- Pyrvinium pamoate (Povan) (Stool and emesis brigt red)
– Entire family s treated
-1 dose initially
`2nd dose in 2 weeks (to prevent re-infection)
– If re-infected
` Start over with same tx
What am I gunna teach???
-Proper testing for pinworms
(Tape test)
-Medication education
(I dose now and 2nd dose in 2 weeks)
-Prevention of re-infection `Wash all clothes and bed linens in hot water `Vacuum carpets `Hand washing `Short nails `One piece PJ's `Show not tub
Additional Helminthic Infestations
Flukes (trematode)
Passed to humans via snail-contaminated water
Additional Helminthic Infestations
Tapeworms (cestodes) 5 TYPES*
- Cattle
- Fish
- Dogs
- Pigs
- Rodents
-Occurs upon ingestion of under cooked beef, raw fish, contaminated food or water, accidentally swallowing of flea, lice, roach,
