Gastroenteritis

Question 1

What are things to consider with gastroenteritis presentation?

Answer 1

Age of child, severity of symptoms, symptoms type

Other symptoms suggesting serious conditions

Duration of symptoms = persistent diarrhoea, vom >2 days, vom w/out diarrhoea

Whether symptoms recurrent

minimal fluid intake, signs of dehydrations

Recent overseas travel, other health conditions

Question 2

Explain what gastroenteritis is, who it effects

Answer 2

Viral = common in children (70-87% of cases)

Commonly rotavirus, self limiting

children <5 = 2.2 diarrhoeal episodes/year

Peak during colder months

Question 3

What are the symptoms of gastroenteritis?

Answer 3

Viral = water diarrhoea, abdominal cramp, vomiting, loss of appetite, low grade fever, non-distended abdomen, active bowel sounds

Bacterial = blood and mucous in stool, abdominal cramps, vomiting, not eating, fever, chills, sig abdominal tenderness

Question 4

How is gastroenteritis commonly spread?

Answer 4

Faecal-oral routes = hands, utensils, food, drink

Question 5

What questions should you ask patients presenting with gastroenteritis?

Answer 5

How is the child normally? has their behaviours changed?

Can you please describe your child’s symptoms? Are there any other symptoms? How did they develop? When did you first notice them?

How often are they going to the toilet? what does the stool look like?

How often are they vomiting? when is it worse? What are you doing in relation to hydration?

Do you know anyone with similar symptoms? childcare?

What was your child’s weight before this? What are you doing in terms of feeding?

What have you done to manage it? has it worked?

Have you done anything differently? (overseas travel, antibiotics, new food)

Question 6

What are the clinical features of no/minial dehydration? How is it treated?

Answer 6

No clinical signs, inc thirst

treat = continue eating/drinking, oral rehydration solutions (ORS) recommended for children at risk of dehydration (infants, toddlers, freq vom/diarrhoea)

Question 7

What are the clinical features of mild to moderate dehydration? How is it treated?

Answer 7

Features = Inc respiratory rate, capillary refill >2 sec, skin recoil <2 sec, irritability, mildly sunken eyes, reduced urine output

Treat = rehydrate with 50-100mL/kg ORS over 4 hours in freq small volumes. Maintain rehydration, 10mL/kg of fluid with each loose stool, 2ml/kg with each episode of vomit f

Question 8

What are the clinical features of severe dehydration? How is it treated?

Answer 8

Features = capillary refill >3 seconds, skin recoil >2 seconds, inc resp rate, deep respiration, lethargy, deeply sunken eyes, minimal or absent urine output

Treatment = refer for immediate rehydration, usually IV and hospital monitoring

Question 9

Question to ask when children are presenting with dehydration

Answer 9

Has the child’s behaviour changed? Are they lethargic?

Any changes in weight?

What sort of fluids have you been giving them? How are they taking the fluids?

Are they still urinating? Is the nappy dry?

Ask parent to describe = capillary refill, skin elasticity, sunken eyes, fontanelle presentation (sunken in when severe), cold extremities (severe dehydration)

Question 10

Alarm symptoms to refer for gastroenteritis

Answer 10

<6months old, freq vomiting, not drink/taking fluids

signs of severe dehydration, blood in diarrhoea or vomit, green vomit (bile), persistent vomiting (>2 days)

Vomiting without diarrhoea

severe abdominal pain, other symptoms (high fever)

other medical conditions

Question 11

What are some differential diagnoses for gastroenteritis?

Answer 11

Appendicitis = pain near belly button, to right, not eating

UTI = abdominal pain, fever, poor feeding, irritability, frequent strong-smelling urination

Otitis media = pain, pulling on ear, irritability, lethargy

Food poisoning = vomiting, abdominal cramps (2-48 hrs onset), similar illness in those who ate a similar food

Antibiotic associated diarrhoea = fever, lower abdominal pain/cramping

More serious intestinal conditions = abdominal pain, vomiting, lethargy, blood in stool

Other conditions = PUD, IBS

Question 12

What are the aims for treating gastroenteritis?

Answer 12

Prevent dehydration = manage with oral rehydration therapy

Prevent spread of infection

Rotavirus vaccine

Some evidence of probiotic use = reduce duration by 24hrs in children

Question 13

Mention some things about oral rehydration

Answer 13

As effective as IV rehydration for moderate dehydration

Give small amounts frequently

Hydralyte = do not add drinks to sweeten, last 24 hrs in fridge, better when frozen

Question 14

How would you prevent the spread if gastroenteritis?

Answer 14

Good hygiene = thorough hand washing with soap, warm water, sanitiser after going toilet, changing nappies, before eating/prepping food

Exclusion from school/childcare = diarrhoea (no loose bowel motion for 24hrs), vom (no vom for 24hrs)

Question 15

When to refer alarm symptoms

Answer 15

Younger than 6months, freq vom, not drinking or taking fluids, signs of severe dehydration

Blood in vom/diarrhoea, green vomit, persistent vom >2days, vomiting w/out diarrhoea, abdominal pain

Medical conditions, other symptoms

Question 16

What information should you share with the parent about gastroenteritis?

Answer 16

Use oral rehydration solution instead of water alone, drink small amounts freq (even a mouthful after vomiting)

Keep up breast milk if breastfeeding alongside oral solutions, if bottle feeding = clear fluid for 12 hours then formula

Sugar/carbonates drinks worsen diarrhoea, avoid high fat/simple sugar food, return to normal diet asap

Eat complex carbs (rice, cereal, bread), lean meat, fruit, veg

Transient lactose intolerance possible after severe dehydration (frothy, watery, explosive stools after drinking milk)

Question 17

When should a parent seek advice?

Answer 17

Child seems: drowsy, breathing fast, no or very little tears, dry mouth, dark yellow urine, fontanelle sinking inwards, cold/blotchy looking hands and feet