7.3 Gastroenteritis

Question 1

When child comes in with diarrhoea and vomiting what to think?

Answer 1

What else could it be?

Vomiting is non specific

Question 2

What kind of IV fluids for kids with gastro?

Answer 2

0.9% saline with 5% dextrose and KCL 20mmol/l

Question 3

What is acute diarrhoea?

Answer 3

3 or more loose stools in 24 hours for <14 days

Question 4

Bacteria accounts for how many % of gastro?

Answer 4

15%

Question 5

Which bacteria’s for gastro most common?

Answer 5

Campylobacter
Salmonella
Ecoli 
Shigella
S Typhi
Cholera
Yersinia

Question 6

Antibiotics for salmonella?

Answer 6

Unless they’re very unwell

Otherwise prolongs excretion phase

Question 7

Which bacteria for gastro mimics appendicitis?

Answer 7

Yersinia

Question 8

3 most common parasites for diarrhoea?

Answer 8

Guardia
Cryptosporidium
Entamoeba

Question 9

What symptoms make you think more likely bacterial gastro?

Answer 9

Blood and mucus in stool
High fever
Recent travel
Food borne
HUS

Question 10

How to look for HUS in child based on examination?

Answer 10

A child who should be dehydrated but doesn’t look dehydrated cause the kidney failure is retaining fluid

Question 11

Gastroenteritis main history

Answer 11

Vomiting
Stool
Intake: ?50%, type
Urine
Lethargy, drowsy, colour, Abdo pain, rash, bruise

Question 12

Continued Gastroenteritis history?

Answer 12

Duration
Loss of weight
Sick contacts
Prev. Illness
FHx

Question 13

What age group highest risk gastro?

Answer 13

Young infants

Question 14

Signs of dehydration in child with Gastroenteritis?

Answer 14

Skin turgor
Reduced cap refill
Fontanelle
Tach
Wet nappies

Question 15

DDx for Gastroenteritis?

Answer 15

Appendicitis
Hernia
Intussusception
UTI
Meningitis
Diabetic ketoacidosis
IBD
HUS
Inborn errors metabolism

Question 16

RED FLAGS for gastro?

Answer 16

Blood in stool or vomit
Bile in vomit
Vomit, no diarrhoea
Diarrhoea first then vomiting
Headache
>39
Young: <3m
Severe abdo pain / distension

Question 17

Ix for Gastroenteritis?

Answer 17

Usually not
UEC, BGL
FBE
Stool: MCS, virology
CXR/AXR, U/S

Question 18

How to treat mild dehydration?

Answer 18

Frequent small volumes of oral rehydration salts

Question 19

NGT rapid rehydration details?

Answer 19

10mL/kg/hr for 4 hours then CEASE

Question 20

Rapid IV rehydration details?

Answer 20

10mL/kg/hr for 4 hours with N/S +5% glucose

Question 21

When do you NOT use NGT rehydration?

Answer 21

Ileus
Reduced consciousness
Younger than 6 Mo
Medical condition: risk of fluid overload

Question 22

Standard IV rehydration for mod/severe gastro is?

Answer 22

0.9% saline + 5% glucose + 20mmol/l KCl over 24-48hr

Question 23

What is the amount of fluid calculation for IV maintenance fluids?

Answer 23

4,2,1mL

4 for first 10 kg
2 for second 10 kg
1 for subsequent kg

Question 24

When to admit to hospital for Gastroenteritis?

Answer 24

Severe dehydration
<6/12
High freq vomit/diarrhoea
High risk complications: diabetes, renal, poor nutrition
?surgical dx
Parents can’t manage
Unsuccessful oral rehydration

Question 25

When to commence normal oral intake?

Answer 25

Once can tolerate fluid and oral intake

Question 26

What cause acute diarrhoea to go chronic?

Answer 26

Restricted intake
High volume Appel juice
Antibiotics
Antidiarrhoeals