Gastroenteritis Flashcards
What is gastroenteritis?
Temporary infective disorder due to an enteric infection
What causes gastroenteritis?
Virus - rotavirus, adenovirus, norovirus
Bacteria - campylobacter
Parasites
What percentage of the population develop gastroenteritis each year?
20%
How is rotavirus spread?
Faecal oral route
When does rotavirus peak in incidence?
Winter months
Describe the rotavirus vaccine
Oral vaccine
Given at 8 and 12 weeks
What are noroviruses?
Single stranded RNA viruses
How is norovirus spread?
Faecal oral route or environmental contamination
Which age group is more at risk of adenovirus?
<2yo
What causes campylobacter gastroenteritis?
Undercooked meat
Unpasteurised milk
Which bacteria is the most common cause of gastroenteritis?
Campylobacter
Which form of E.coli can have life threatening complications?
VTEC E.coli 0157:H7
What are the complications of E.coli caused gastroenteritis
Haemorrhagic colitis
Haemolytic uremic syndrome
Toxic megacolon
Reactive complications - arthritis, carditis, urtication, erythema nodosum, conjunctivitis, reiters syndrome, acquired/secondary lactose intolerance
List the clinical features of gastroenteritis
Sudden onset of loose/watery stool with/without vomit
Abdo pain
Mild fever
Recent contact with someone with diarrhoea and vomiting
Dehydration
Who is most at risk of dehydration due to gastroenteritis?
Young children <6months
>5 stools in last 24 hours
Vomit >2 in last 24 hours
Stopped breast feeding during the illness
What are some signs and symptoms of clinical shock
Decreased GCS Pale/mottled skin Cold extremities Tachycardia Tachypnoea Weak peripheral pulses Prolonged capillary refill time Hypotension (decompensated shock)
What are some signs and symptoms of clinical dehydration
Appears well/deteriorating Altered responsiveness Decreased urine output Skin colour unchanged Warm extremities Sunken eyes Dry mucous membranes Tachycardia Tachypnoea Normal peripheral pulses Normal capillary refill time Reduced skin turgor Normal blood pressure
When should another differential as opposed to gastroenteritis be considered?
Temp >38 in <3mo or >39 in >3 mo Breathlessness Altered GCS Meningism Blood/mucous in stool Bilious vomit Severe/localised abdo pain Abdo distension or guarding
What investigations are necessary in case of gastroenteritis?
Stool sample for microbiological investigations
Na, Cr, Ur, K and glucose if going to give IV fluids or symptoms of Hypernatremia
List the symptoms/signs of hypernatraemia
Jittery Increased muscle tone Hyperreflexia Convulsions Drowsiness Coma
Describe the immediate management of gastroenteritis
Not clinically dehydrated - continue breast/feeding, encourage fluid intake, discourage fruit juice/carbonated drinks, offer oral rehydration salt solution if at risk of dehydration
If dehydrated - IV therapy or oral rehydration salt therapy
How do you give the oral rehydration salt solution?
50 ml/kg over 4 hours to replace deficit plus maintenance fluids Small amounts - 5ml every 5 mins
What should you consider if the child is refusing oral solution?
NG tube
Describe how maintenance fluids are calculated
According to weight 100ml/Kg/day for first 10kg Plus 50ml/kg/day for next 10kg Plus 20ml/kg/day for every KG over 20Kg
What should be advised following rehydration?
Full strength milk right away and slowly re-introduce the child’s solid food
How should contamination/transmission be avoided?
Hand washing
Avoid sharing of towels
Child not to return to nursery/school until at least 48hrs after last episode of diarrhoea or vomiting
Child should not swim for 2 weeks after the last episode
Describe haemolytic uraemic syndrome
Rare but serious complication
Occurs in young children and elderly
Life threatening complication - acute renal failure and haemolytic anaemia
Describe reiters syndrome
Urethritis
Uveitis
Arthritis
What is toxic megacolon a rare complication of?
Rotavirus gastroenteritis
Describe acquired/secondary lactose intolerance
Occurs due to lining of the intestine being damaged
Symptoms of bloating, abdominal pain, wind and watery stools after drinking milk
Improves when infection resolves and gut lining heals
