Acute Gastroenteritis Flashcards
What is gastroenteritis?
inflammation of the gastrointestinal tract that usually manifests with acute diarrhea, vomiting, and/or abdominal pain
What is infectious gastroenteritis?
gastroenteritis caused by pathogens moct commonly viruses but can also be causes bacteria, parasites and fungi
What is mild to moderate gastroenteritis?
- Abdominal pain with normal abdominal examination
- Mild diarrhea, nausea, and/or vomiting
What is severe gastroenteritis?
Gastrointestinal features
- Bloody stools
- Severe diarrhea, nausea, and/or vomiting
- Severe abdominal cramping and/or tenderness
Systemic features
- Fever (≥ 38.3°C) or sepsis
- Clinical signs of significant dehydration
- End-organ damage
- Duration > 1 week
Etiology?
- viral - most cases
- bacterial (20% of cases)
- parasites e.g. Giardia lamblia - should be considered in children with persistent diarrhea
Clinical features?
- nausea and vomiting
- fever
- abdominal pain
- diarrhea
What clinical features raise concern for severe illness?
- fever >40 degrees or tachypnea
- signs of poor peripheral perfusion
- bloody or bilious emesis
- petechiae
- altered mental status or excessive crying/fussiness
Important points in history?
- Diarrhoea - frequency of stools, number of days, blood or mucous in stools.
- Vomiting - frequency, blood, contents, associated with feeding
- Local reports of cholera outbreak or other contacts unwell
- Recent antibiotic or other drug treatment
- Attacks of crying with pallor in an infant - intussusception
- Feeding history
- Fever
- Local mankhwala (medicine)
- Urine Output
- Vaccination history (query Rotavirus)
Important points on examination?
- Assess for emergency signs ABCD
- Shock
- cold hands, capillary refill >3 secs, fast, weak pulse - Severe Malnutrition
- visible severe wasting or oedema of both feet - Assess Hydration
- Abdominal examination looking particularly for surgical problems
e.g. distension, tenderness, guarding or a mass - Is there any evidence of sepsis
Relevant investigations?
- Blood glucose
- if low BCS, or lethargic - Stool culture rarely indicated or available (but important if suspected cholera see below)
- Creatinine, urea and electrolytes/blood gases
- if acidotic, poor urine output - Blood culture
- if high fever, long history, suspicion of Typhoid
Indications for admission?
- Gastroenteritis with severe dehydration
- Vomiting all oral fluids/ ORS or unable to receive oral fluids in A&E (i.e. lethargy)
- Social concerns
- Uncertainty about diagnosis
- Repeated presentation with no improvement in symptoms
Gastrointestinal causes of gastroenteritis?
- gastrointestinal causes of acute abdomen
e.g. appendicitis, bowel obstruction - inflammatory bowel disease
- congenital disorders with diarrhea
e.g. Hirschprungs, intestinal malrotation with midgut volvulus, congenital diarrhea - intussusception
- functional diarrhea
- antibiotic associated diarrhea
Extra-intestinal causes of gastroenteritis?
- pneumonia
- meningitis in children
- otitis media
- UTI in children and adolescents
- toxic shock syndrome
Treatment of gastroenteritis for all patients?
- Maintain adequate oral intake through breastfeeding or age-appropriate foods
- Zinc supplementation is recommended for patients with malnutrition or in low-income regions
- Educate patients and/or caregivers on preventing onward transmission of gastroenteritis
Treatment of mild to moderate gastroenteritis?
- Encourage fluid intake
- Give oral rehydration solution (ORS) if signs of moderate dehydration are present
- Advise caregivers to seek medical assistance if signs of significant dehydration develop
