Gastroenteritis

Question 1

Causes of gastroenteritis

Answer 1

Viral: Rotavirus, Adenovirus (noro??)
Bacterial: Shigella, Salmonellae, Campylobacter, E. coli
Parasites: Entamoeba histolytica, Giardia lamblia, Cryptosporidium

Question 2

Clinical features

Answer 2

Viral infection can cause a prodrome
Vomiting may preced diarrhoea, not usually blood or bile stained
Abdo pain, blood/mucus in stool suggest invasive bacterial pathogen
If child appears toxic with high fever, viral cause unlikely
Dehydration

Question 3

Important DDs

Answer 3

2-12 weeks, esp boys: pyloric stenosis

1-2 years: intussusception

Question 4

Investigations

Answer 4

None often
U+Es, glucose if IVT used or hypernatreamic dehydration suspected
Stool culture if: bloody stool; sepsis; immunocompromise

Question 5

Management

Answer 5

REHYDRATION:
correct fluid/electrolyte imbalance
If child not dehydrated, continue normal fluid intake plus oral rehydration salts as supplemental fluid if condition worsens
If clinical dehydration, 50ml/kg ORS over 4 hours plus maintenance fluids as ORS
If shock: 20ml/kg saline + repeat if necessary then continue with IVT for maintainance (add 100ml/kg?)

Question 6

Dehydration assessment

Answer 6

Reduced urine output
Normal (warm) extremities
Sunken eyes or depressed fontanelle
Skin turgor reduced
Heart rate increased
Resp rate increased
Normal cap refill
May be alert or lethargic
Membranes dry