Gastroenteritis in a child Flashcards
What is gastroenteritis?
Caused by infection and is characterised by the sudden onset of diarrhoea (± vomiting)
How many cases and deaths from gastroenteritis in a child are there worldwide?
2 billion cases
1.9 million deaths
What % of <5y/os present with gastroenteritis per year?
10%
What is the most common causative agent of gastroenteritis and what % of cases does it account for?
Rotavirus
56%
What are some other causative agents of gastroenteritis and how common are they?
Campylobacter - 28% Salmonella - 11% Norovirus - 3% Shigella - 1% E. Coli - 1%
What are the risk factors of gastroenteritis?
Poor hygiene
Lack of sanitation (e.g. water)
Immunocompromised
Food (poorly cooked, cooked food that has been left out, uncooked food, insufficient reheating)
What are the general symptoms and signs of gastroenteritis?
Sudden change to loose/watery stool ± vomiting
Contact w/ someone w/ acute diarrhoea
Recent travel abroad
Fever
What important question should be part of the history and why?
Recent antibiotics
Because of C. difficile
What are some specific symptoms of Campylobacter jejuni gastroenteritis?
Severe abdo pain, bloody stools
What are some specific symptoms of Shigella and Salmonella gastroenteritis?
Dysentery = blood and pus in the stool, abdo pain, and tenesmus (incomplete bowel emptying)
High fever - Shigella
What are some specific symptoms of Cholera and E. coli gastroenteritis?
Profuse, rapidly dehydrating diarrhoea
What is the most accurate measure of dehydration?
Weight loss during the diarrhoeal illness
What are some red flags of dehydration?
Altered responsiveness \+HR \+RR -Skin turgor Sunken eyes
What is the most important think to look out for in gastroenteritis and why?
Dehydration
As it can lead to shock
What is the role of further investigations in gastroenteritis?
Aren’t absolutely required to determine causative agent
Used to assess severity and monitor pt
What investigations could you do for gastroenteritis?
Bloods - FBC, renal function, electrolytes
Stool culture –> MC+S
Blood culture
When is a stool culture done in gastroenteritis?
Septicaemia suspected
Blood/mucus in stool
Immunocompromised
Hx of recent travel
When is a blood culture done in gastroenteritis?
If giving Abx
What is the most important part of the management of gastroenteritis?
Rehydration
What is the management of a child with gastroenteritis and no clinical dehydration?
Encourage breastfeeding/other milk feeds
Encourage fluid intake
Discourage fruit juices/carbonated drinks
Offer oral rehydration salt (ORS)
What is the management of a child with gastroenteritis and clinical dehydration?
Low osmolarity ORS solution (240-250mOsm/L)
50ml/kg of fluid deficit replacement over 4 hours
Maintenance fluid
What fluid should you use for fluid replacement in a child with gastroenteritis and clinical dehydration?
Isotonic solution (e.g. 0.9% sodium chloride ± 5% glucose)
When are antibiotics given in gastroenteritis?
Suspected/confirmed septicaemia Extraintestinal spread of infection <6 months and Salmonella Immunocompromised and Salmonella C. diff associated pseudomembranous colitis
What particular medication should be avoided?
Antidiarrhoeal medications
What is the root of most complications of gastroenteritis?
Dehydration
Who are at higher risk of dehydration in gastroenteritis?
<6 months -birthweight >5 diarrhoeal stools in the last 24 hours >3 vomits in the last 24 hours Unable to tolerate extra fluids Malnutrition
What serious complication can occur with E. coli gastroenteritis?
Haemolytic uraemic syndrome
What is a common complication after gastroenteritis?
Lactose intolerance
What is the prognosis of gastroenteritis?
Usually good
How long does the diarrhoeal illness of gastroenteritis last for?
5-7 days
How long does the vomiting in gastroenteritis last for?
1-2 days
What is the mortality rate from rotavirus gastroenteritis in the UK per year?
3-4 deaths per year
