Gastroenteritis Flashcards
What is gastroenteritis?
Gastroenteritis is inflammation all the way from the stomach to the intestines and presents with nausea, vomiting and diarrhoea
What is teh main concern in GE?
Dehydration
What is the main concern in GE?
Dehydration
What is first step in managing GE?
Isolate patient in paeds assessmnet unit or hospital ward
Barrier nursing
What need to assess in children presenting with GE
Whether can manage with conservativ hydration or need IV fluids
Key differentials for patients with loos stools?
- Infection (gastroenteritis)
- Inflammatory bowel disease
- Lactose intolerance
- Coeliac disease
- Cystic fibrosis
- Toddler’s diarrhoea
- Irritable bowel syndrome
- Medications (e.g. antibiotics)
Common causes of GE?
Rotavirus
Norovirus
(adenovirus less common -> subacute diarrhoea)
How is E coli spread
Infected faeces
Unwashed salads
Contaminated water
What bacteria can cause haemolytic uraemic syndrome?
E.coli 0157 -> shigella toxin
What does the shiga toxin cause?
Abdo cramps, bloody diarrhoea and vomitting
Destroys RBCs -> haemolytic Uraemic S
Why should antibiotics be avoided in some GE cases?
If suspect E coli may be cause as antibiotics increase the risk of Haemolytic uraemic syndrome
What is most common cause of travellers diarrhoea?
Campylobacter
What type of bacteria is campylobacter?
Gram negative ‘
Curved or spiral shape
How is campylobacter spread?
Raw/uncooked poultry
Untreated water
Unpasteurised milk
What is the incubation and symptom resolution for travellers diarrhoea?
Incubation - 2-5 days
Symptoms resolve - 3-6 days
SYmptoms of travellers diarrhoea
Abdo cramps
Diarrhoea often with blood
Vomitting
Fever
When are antibiotics used in campylobacter travellers diarrhoea?
Severe symptoms
Other risk factors HIV or HF
Antibiotics for travellers diarrhoea
Azithromycin or ciprofloxacin
What is salmonella spread by?
Eating raw eggs, poultry or food contaminated with infected faeces of small animals
What is incubation and resolution of salmonella?
Incubation - 12 hours to 3 days
Resooution - 1 week
Symptoms of salmonella
Watering diarrhoea can be ass with muscus or blood
Abdo pain
Vomitting
What should antibitoics be guided by in salmonella of treatment?
Stool culture and sensitivites
What type of bacteria is bacilus cereus?
Gram positive rod
How does bacileius cereus spread?
Inadequately cooked food and not refrigerated after cooking
eg fried rice at room temp
What toxin comes from bacilius cereus
Cereulide
What symptoms does cereulide cause?
Abdo cramping and vomitting within 5 hours of ingestion
Then causes watery diarrhoea when reaches the intestine
Typical course of bacilius cereus infection
Comitting within 5 hours, then diarrhoea after 8 hours then resolution within 24 hours
V short incubation time and recovery in 24 hours
What type of bacteria is yersinia?
Gram negative bacillus
What can cause yerisnia infection?
Raw or undercooked pork - pigs are carriers
Urine or faeces of other mammals eg rats and rabbits
What does yersinia cause in children?
Water or bloody diarrhoea
Abdo pain
Fever
Lymphadenopathy
Incubation and duration of yersinia illness
5-7 dyas incubation
3 weeks +
Why do older children with yersinia often get mistaken for appendicitis?
RHS abdo pain due to mesenteric lymphadenitis (inflammation in intestitnal lymph nodes)
Fever
What toxins do S.aureus produce?
Enterotoxins
Symptoms of S.aureus enterotoxins
Diarrhoea
Perfuse vomitting
Abdominal cramps
Fever
Affect small intestine
What is the course of S.aureus toxin incubation and symptoms resolution
Start within hours
12-24 hours settle
What is giardiasis?
Microscopic parasite
Lives in small intestines of mammals
Causes GE
Transmission of giardiasis
Faeco-oral
Symptoms of giraridiasis inection
Asymptomatic
Chronic diarrhoea
Diagnosis for giardiasis
Stool microscopy
Treatment for giardiasis
Metronidazole
How long do children need to stay off schoo, iwth GE
48 hours after symptoms completely resolved
What is a fluid challenge
Record small vol fluid given orally every 5-10 mins to ensure they can tolerate it and adequately hydrated
What to introduce after fluid challenge after GE
Dry light diet eg toast
What medication is generall not recommended in GE?
antidiarrhoeals eg loperamide
antiemetics eg metoclopramide
When are antidiarrhoeals particuarly avoided?
e.coli 0157 and shigella
Where bloody diarrhoea and fever
Post GE complications
Lactos eintolerance
IBS
Reactive arthritis
Guillian Barre syndrome
