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MBChB IV Paediatrics > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

1
Q

Acute gastroenteritis

A

Indicates infection (bacterial, viral, parasitic)
Many foodborne illnesses
Manifests as V+D
Assoc abdominal pain, fever (systemic)

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2
Q

What happens to untreated acute gastroenteritis?

A

Becomes persistent
50% of diarrhea deaths
Adverse effect on nutritional status -> malnutrition

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3
Q

Dehydration

A

Loss of body water
Compensatory mechanisms (thirst, antidiuresis, catecholamine stress response release)
Continuing water loss -> failure to compensate -> circulatory inssufiency

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4
Q

Dehydration

Features

A 
Dry mouth and mucosa
Reduced urine, sweat
and tears
Sunken eyes and
fontanel
Reduced skin turgor
Acidotic breathing
Restlessness to irritability
Prolonged capillary filling
time > 3 seconds
Hypotension and shock,
tachycardia
Apathy to coma,
convulsions
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5
Q

Gastroenteritis

Bacteria

A 
Salmonella
Shigella
Staphylococcus aureus
Vibrio cholera
Yersinia enterocolitica
Campylobacter jejuni
E coli
Clostridium difficile
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6
Q

Gastroentieitis

Viruses

A 
Astroviruses
Caliciviruses
Noroviruses
Enteric adenoviruses
Rotavirus
CMV
HSV
HIV
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7
Q

Gastroenteritis
Parasitic infections
Protozoa

A 
Cryptosporidium
Entamoeba hystolytica
Giardia Lamblia
Microsporidium
Isospora
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8
Q

Gastroenteritis
Parasitic infections
Helminths

A 
Strongyloides
stercoralis
Trichuris trichura
Schistosoma
Trichinella
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9
Q

Gastroenteritis

Bacterial presentation

A 
Summer – bacterial
contamination
<6 months of age
Multiple pathogens
isolated stool
Shigella: Abrupt onset
diarrhoea, prominent
CNS symptoms, high
fever, no vomiting,
blood and mucous in
stools
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10
Q

Gastroenteritis

Viral presentation

A 
Rotavirus
Winter months, 6-24
months of age
Preceding respiratory
symptoms and profuse
vomiting before onset
diarrhoea
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11
Q

Gastroenteritis

Virus mechanism

A 
Small intestinal mucosal damage
Invade mucosal cells tips vili
Shedding
Disaccharidase deficiency - ↓ carbohydrate
digestion (osmotic diarrhoea)
↓ Reabsorption fluid and electrolytes
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12
Q

Gastroenteritis

Bacterial mechanisms

A

Adherence mucosal cell, damage

Enterotoxin production
– stimulate secretion large amounts fluid and
electrolytes
– toxigenic e.coli, vibrio cholera

Cytotoxin production
– mucosal damage (decreased absorptive surface + secondary inflammatory response ↑fluid secretion

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13
Q

Gastroenteritis

Reasons for vomiting

A

Impaired gastric emptying
Starvation ketosis
Location irritation and stimulation of neurotransmitters
Toxins that stimulate chemoreceptors in vomiting centre

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14
Q

Gastroenteritis

Resus

A 
Shock medical emergency: IV fluids
IV access : IV line, interosseus line
Ringer’s / 0.9% Saline: isotonic fluids
20ml /kg bolus
Reassess : another 10 – 20ml/kg bolus
½ Darrows 10-15ml/kg/h
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15
Q

Gastroenteritis

Diarrhea complications

A

Dehydration -> shock
ARF, cerebral complications(hypoxic ischemia, cerebral
vascular thrombosis), NEC, shock lung

Acidosis and electrolyte disturbance

Additional features
Fever, convulsions, ileus, protein losing enteropathy,
necrotizing enterocolitis

Dysfunction gut
↓ digestion and absorption nutrients

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16
Q

Gastroenteritis

Metabolic acidosis clinical features

A

Loss of base in stools, reabsorb HCL gut, poor tissue perfusion, starvation,
decreased renal H+ clearance

– Features dehydration or shock
– Compensatory breathing: deep rapid respiration
pursed lips, no signs pulmonary disease (Kussmaul)
– Severe acidosis peripheral vasoconstriction, poor capillary filling without other features shock
– Neonates sometimes without physical signs

17
Q

Gastroenteritis

Electrolytes lost

A

Sodium
Potassium
Chloride
Bicarbonate

18
Q

Gastroenteritis

Hypokalemia

A

– Weakness, hypotonia, paralysis, areflexia
– Cardiac arythmias
– Ileus
– Older child inability to hold up head
– Prolonged: renal tubular defects, reduced
concentrating ability, interstitial nephritis

19
Q

Gastroenteritis

Hyponatremia

A

<125 mmol/l: nausea, vomiting, muscle twitching,
lethargy

<115 mmol/l: seizures and coma

20
Q

Gastroenteritis

Hypernatremia

A

Osmotic gradient water from intracellular to
extracellular compartment- masked clinical signs
dehydration
Symptoms of intracellular water loss from brain cellsdepressed
sensorium, irritability, convulsions
Severity depends on degree and rate of rise of
plasma osmolality

21
Q

Gastroenteritis

Convulsion causes

A 
Central venous thrombosis
Fever
Hypoglycemia
Hypo/hypernatremia
Menigitis, encephalitis
Cerebral edema 
Shigella toxin
22
Q

Gastroenteritis

Management

A

Prevent dehydration

Continue feeds to allow maximal digestion and absorption

23
Q

Gastroenteritis

Dehydration advice

A

Prevent
Replace amount that is lost in each vomit stool, +/- 15-30ml/kg additional to each feed
ORS small frequent quantities, teaspoon
Give as much as the child wants, 15-30 ml/kg/h
Once stronger, alert, pass urine, want food: offer small feed
Ongoing losses
Maintaining nutrient intake important
recovery
Continue milk feeds
Select solids easily digestable, bland and
soft – starchy porridge, mashed banana
Small quantities at a time, as frequently as
tolerated
Aim to restore normal intake 2nd-3rd day

24
Q

Gastroenteritis

Home made solution preparation

A

8 teaspoons cane sugar
1/2 teaspoon salt
1L cleanest water

25
Q

Gastroenteritis

Additional therapies

A

Careful oral rehydration is usually
sufficient

Antimotility agents like loperamide are
contraindicated in children

Similarly, due to the potentially serious
side effects (lethargy, dystonia, malignant
hyperpyrexia) of anti-emetics such as the
phenothiazines they are of little value

Ondansetron
Selective serotoninergic 5HT3 receptor
antagonist
No sedative effect or extrapyramidal
reactions
Effective against placebo in relieving
vomiting, reducing the need for intravenous fluids and decreasing
hospitalization
26
Q

Gastroenteritis

Antibiotic treatment

A

For dysentery

Ciprobay 15mg/kg dose bd po x 3 days

27
Q

Gastroenteritis

Prevention

A

Hygiene and sanitation
Exclusive breastfeeding 6mo
Prevent malnutrition (early intervention)
Measles, rotarix vaccines

MBChB IV Paediatrics (81 decks)

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