Diarrhoea + Vomiting - Gastroenteritis, Dehydration management

Question 1

Most common cause
-typical duration

Answer 1

Gastroenteritis - rotavirus
-diarrhoea - 5-7 days, stops within 2 weeks
-vomiting - 1-2 days, stops within 3 days

Question 2

Signs of clinical dehydration
-management

Answer 2

Looks unwell, deteriorating
Altered responsiveness
-irritable
-lethargic

Sunken eyes
Skin colour unchanged
Dry mucous membranes
Reduced skin turgor

Tachycardia, tachy apnoea
Normal peripheral pulses
Normal CRT
Normal BP

50ml/kg ORS over 4hrs + maintenance ORS often in small amounts
Continue breastfeeding
Supplement with milk or water, NOT FRUIT JUICE

Question 3

Signs of clinical shock
-management

Answer 3

Decreased consciousness

Cold extremities
Pale, mottled skin

Tachycardia, tachypnoea
Weak peripheral pulses
Prolonged CRT
Hypotensive

ADMIT FOR IV REHYDRATION

Question 4

Groups at increased risk of dehydration

Answer 4

U1, especially U6months
Low birth weight
6+ diarrheal stools in 24hrs
3+ vomits in 24hrs

If not offered/cannot tolerate supplementary fluids before presenting

If breastfeeding stopped during illness

Signs of malnutrition

Question 5

Hypernatremic dehydration features

Answer 5

Jittery movements
Increased muscle tone
Hyperreflexia
Convulsions
Drowsy, coma

Question 6

Gastroenteritis
-presentation of travellers diarrhoea
-presentation of acute food poisoning
-most common cause

Answer 6

Travellers diarrhoea - min3 loose/watery stools in 24hrs with/without
-abdo cramp
-fever
-nausea
-vomiting
-bloody stool
Ecoli

Acute food poisoning - sudden onset
-nausea
-vomiting
-diarrhoea after ingestion of toxin
Staph aureus, Bacillus cereus, clostridium perfringens

Question 7

Ecoli
-key factors

Answer 7

Common in travellers
Watery stools
Abdo cramps, nausea

Question 8

Giardiasis
-key factor

Answer 8

Prolonged, non bloody diarrhoea

Question 9

Cholera
-key factor

Answer 9

Profuse watery diarrhoea
Severe dehydration resulting in weight loss
Not common in travellers

Question 10

Shigella
-key factors

Answer 10

Bloody diarrhoea
Vomiting, abdo pain

Question 11

Staph aureus
-key factors

Answer 11

Severe vomiting
Short incubation period

Question 12

Campylobacter
-key factors

Answer 12

Flu-like prodrome
Followed by crampy adbo pain, fever, diarrhoea

Appedicitis mimic

Complications like GBS

Question 13

Bacillus cereus
-key factors

Answer 13

2 types of illness seen
-vomiting within 6hrs, stereotypically due to rice
-diarrhoeal illness occurring after 6hrs

Question 14

Amoebiasis
-key factors

Answer 14

Gradual onset bloody diarrhoea, abdo pain, tenderness
-may last several weeks