Gastroenteritis in a child Flashcards
Define gastroenteritis.
Gastroenteritis is a transient disorder due to enteric infection, usually caused by viruses, characterized by sudden onset of diarrhoea, with or without vomiting.
Define dysentery.
Dysentery is an acute infectious gastroenteritis characterized by diarrhoea with blood and mucus, often with fever and abdominal pain
Define acute diarrhoea.
Three or more episodes of liquid or semi-liquid stool in a 24-hour period, lasting for less than 14 days, where the stool takes the shape of the sample pot
Do viruses cause bloody stools in gastroenteritis?
Usually no
Are most gastroenteritis caused by viruses or bacteria? How long do they usually last?
Viruses
Usually last less than 1 day
What is a typical presentation of gastroenteritis?
- Sudden-onset diarrhoea; blood or mucus in the stool; faecal urgency.
- Nausea or sudden onset of vomiting.
- Fever or general malaise - headache, myalgia, bloating, flatulence, weight loss, and malabsorption, depending on the underlying cause of infection.
- Abdominal pain or cramps
What are the most likely causes of gastroenteritis in a child with bloody stools?
E coli
Salmonella
What is the route of transmission of gastroenteritis pathogens?
faecal-oral, foodborne, environmental, and airborne routes
What is the pathophysiology of gastroenteritis caused by food poisoning?
Primarily caused by enterotoxins produced by the microorganism (rather than the microorganism itself)
List the main 3 pathogens responsible for food poisoning and where they are found.
- Clostridium perfringens* — contaminated meat dishes or cooked meats or meat products; often reheated
- Bacillus cereus* — contaminated or inadequate post-cooking temperature control that has allowed bacterial growth (e.g. reheated rice, pasta, meat or vegetable dishes, and dairy products).
- Staphylococcus aureus* — usually found in cooked meats and cream products.
What is the most common cause of viral gastroenteritis in children?
Rotavirus - but incidence has gone down in recent years because of the vaccine
What are the symptoms of rotavirus? How long does it last? Which parts of the year is it most common in?
- watery diarrhoea and vomiting with or without fever and abdominal pain.
- Vomiting usually settles within 1–3 days
- diarrhoea settles within 5–7 days, but can persist for 2 weeks
- winter and spring
What is the most common cause of viral gastroenteritis in England and Wales? When is it most commonly seen?
- Norovirus
- winter months
What are the symptoms of norovirus and their duration? Why is reinfection common?
- projectile vomiting occurs 24-36 hours after infection , diarrhoea, fever, headache, abdominal pain, myalgia
- symptoms last 12-60 hours
- symptoms resolve within 1-2 days
- immunity is short lasting
Which virus can cause both RTI and gastroenteritis?
adenovirus
What are the most common causes of travellers’ diarrhoea in the UK?
Campylobacter jejuni and campylobacter coli
Can be asymptomatic in 25-50% or cause bloody diarrhoea, vomiting, fever, abdominal cramps, nausea. Resolves within 1 week.
What is the most common serogroup of STEC causing infections in the UK?
E coli 0157
Who is most affected by E. coli 0157 infections? What are the symptoms and their duration?
- Children 1-4 years old
- Can cause bloody diarrhoea, vomiting, abdominal cramps and fever
- Resolves within 10 days
Which gastroenteritis bacteria occurs most commonly in children less than 5 years of age, but infection can occur in all ages and has infections which peak in late summer in the UK?
Shigellosis
When should you suspect HUS in gastroenteritis?
E coli 0157:H7 serotype most commonly triggers HUS
If the child coming in with diarrhoea develops pallor and janudice
List 3 parasitic causes of gastroenteritis.
- Cryptosporidiosis - most common; especially after foreign travel; last 1-2 weeks; can recur.
- Entamoeba histolytica (amoebiasis) - 90% asymptomatic
- Giardia intestinalis or Giardia lamblia - can cause faltering growth from malabsorption
What complication are Campylobacter spp., Shigella flexneri, and Yersinia enterocolitica associated with?
Reiter’s syndrome (uveitis, arthritis, urethritis)
What are the signs and symptoms of thrombotic thrombocytopaenic purpura/?
present with:
- fever
- flu-like symptoms,
- petechial haemorrhages on the lower limbs,
- haematuria,
- anaemia,
- renal dysfunction,
- and possible neurological deficits
Which category (no dehydration/clinical dehydration/shock) would these be classified as:
- warm extremities
- irritability
- mottled/pale skin
- sunken eyes
- dry mucous membranes
reduced skin turgor, sunken eyes and tachycardia all in a child indicate red flag symptoms of progression to shock
Which category of dehydration would these be classified as?
- tachycardia
- weak peripheral pulses
- normal capillary refill
- reduced skin turgor
- hypotension
reduced skin turgor, sunken eyes and tachycardia all in a child indicate red flag symptoms of progression to shock
(table only for dehydration in children)
What are the differentials for gastroenteritis?
How much ORS should you give in different age groups to rehydrate a child with gastroenteritis? (fluid management of dehydration)
- <5years - 50ml/kg for fluid deficit + maintenance over 4 hours
- 5-11 years - 200mL after each loose stool
- 12-16 years - 200-400 mL after each loose stool
Why is it better to rehydrate with a solution containing both glucose and sodium?
Sodium is reabsorbed in the intestine via a glucose-sodium co-transporter
