Gastroenteritis Flashcards
1
Q
Gastroenteritis - background
A
- Def = inflammation of stomach and intestines. Typically results from bacterial toxins/viral infections. Results in vomiting and diarrhoea
- Usually viral in etiology (in children) - sudden in onset and quick to resolve
- Bacterial causes associated with more prolonged and severe illness
2
Q
Viral gastroenteritis - background
A
- Transmission by oral-faecal route, including contaminated water
- Epidemics are frequent and usually occur during winter
- Breastfeeding protective; severity increased in malnourished children
3
Q
Viral gastroenteritis - causes
A
- Rotavirus (most common)
- Norovirus
- Enteric adenovirus
- Astrovirus
- CMV (in immunocompromised pts)
4
Q
Viral gastroenteritis - presentation (5+2)
A
- Watery diarrhoea (rarely bloody)
- Vomiting
- Cramping abdominal pain
- Fever
- Dehydration
+/- electrolyte disturbance
+/- URT signs common with rotavirus
5
Q
Viral gastroenteritis - ix (2)
A
Rarely necessary, can do:
- Stool electron microscopy
- Stool immunoassay
If severe dehydration or altered conscious state:
- FBE
- UEC
- BGL
6
Q
Gastroenteritis - ddx (3)
A
- UTI, other infections
- Appendicitis
- Surgical causes of acute abdomen
7
Q
Gastroenteritis - mx
A
- Oral rehydration - with oral rehydration solution (cup, icypole, syringe). Trial in ED - aim for 10-20mL/kg fluid over 1hr of ORS. Continue breastfeeding. Usual diet once rehydrated.
- Nasogastric rehydration - if moderate dehydration, even if child is vomiting.
a. For moderate dehydration, use rapid NG rehydration. 25mL/kg/hr for 4 hours
b. If 30kg], not recommended for 10% dehydration or unable to tolerate oral fluids)
8
Q
Bacterial gastroenteritis - background (3)
A
- Causes secretory and inflammatory diarrhoea
- Spread by faecal-oral route; sources of infection include contaminated water and poor food hygiene
- Common under 2y of age
9
Q
Bacterial gastroenteritis - causative organisms
A
- Salmonella spp.
- Campylobacter jejuni
- Shigella spp
- Yersinia enterocolitica
- Escherichia coli
+ - Clostridium difficile
- Bacillus cereus
- Vibrio cholerae
10
Q
Bacterial gastroenteritis - presentation
A
- As for viral gastroenteritis (5 - diarrhoea, vomiting, abdominal pain, fever, dehydration)
Plus:
- Malaise
- Dysentry (bloody and mucous diarrhoea)
- Abdominal pain (may mimic appendicitis or IBD)
- Tenesmus
11
Q
Bacterial gastroenteritis - complications
A
- Bacteraemia
- Secondary infections (esp. Salmonella, Campylobacter), e.g. pneumonia, osteomyelitis, meningitis
- Reiter’s syndrome (Shigella, Campylobacter)
- Haemolytic-uraemic syndrome (E. coli 0157 - enterohaemorrhagic, Shigella)
- Guillain-Barre syndrome (Campylobacter)
12
Q
Bacterial gastroenteritis - ix
A
- Stool +/- blood culture
- Stool Clostridium difficile toxin
- Sigmoidoscopy if inflammatory bowel disease or colitis
If severe dehydration or altered conscious state:
- FBE, UEC
- BGL
