GI - Gastroenteritis Flashcards
Definition
Acute gastritis: inflammation of the stomach = nausea and vomiting
Enteritis: inflammation of the intestines and presenters with diarrhoea
MC cause = viral
Easily spread = essential to isolate the Px in any healthcare environment e.g. paediatric assessment unit or hospital ward
Viral causes
Viral gastroenteritis:
- Rotavirus
- Norovirus
- Adenovirus (less common - more subacute diarrhoea)
Bacterial causes of gastroenteritis
E.coli:
- only certain strains cause G.E. Spread through contact with infected faeces, unwashed salads or contaminated water
Campylobacter Jejuni:
- travellers diarrhoea
- MC cause of G.E worldwide
- spread by: raw or improperly cooked poultry, untreated water, unpasteurised milk
Shigella:
- spread by faeces contaminating drinking water, swimming pools and food
- intubation period is 1-2 days and symptoms usually resolve within 1 week without treatment
Salmonella:
- eating raw eggs or poultry or food contaminated with the infected faeces of small animals.
- incubation = 12 hrs - 3 days
- symptoms resolves within 1 week
Bacillus Cereus:
- inadequately cooked food, typically fried rice
- toxin = cereulide
Yersinia Enterocolitica:
- eating raw, or undercooked pork
- contamination with the urine or faeces of other mammal such as rats and rabbits
Staphylococcus Aureus Toxin:
- eggs, dairy, and meat
Giardiasis:
- lives in the small intestines of mammals, e.g. pets, farmyard animals or humans
E.Coli symptoms
E.coli 0157 = Shiga toxin
- abdominal cramps
- bloody diarrhoea
- vomiting
- haemolytic uraemic syndrome (HUS)
= Abx increases the risk of HUS and therefore should be avoided
Campylobacter Jejuni
Incubation is usually 2 to 5 days. Symptoms resolve after 3 to 6 days. Symptoms are:
- Abdominal cramps
- Diarrhoea often with blood
- Vomiting
- Fever
Shigella symptoms
Blood diarrhoea
Abdominal cramps
Fever
Shiga toxin = HUS
Salmonella symptoms
Watery diarrhoea associated with mucus or blood
Abdominal pain and vomiting
Bacillus cereus symptoms
Toxin - cereulide - abdominal cramping and vomiting within 5 hours of ingestion
Abdominal cramping and vomiting within 5 hours of ingestion
Watery diarrhoea 8 hours after ingestion
All symptoms resolves within 24 hours
Yersinia Enterocolitica symptoms
Incubation is 4 - 7 days and the illness can last longer than other enteritis with symptoms lasting 3 weeks or more
Watery or bloody diarrhoea
Fever
Abdominal pain
Lymphadenopathy
Older children or adults can present with right sided abdominal pain due mesenteric lymphadenitis + fever = can give impression of appendicitis
Staphylococcus aureus toxin
Symptoms start within hours of ingestion and settle within 12-24 hours
Diarrhoea
Perfuse vomiting
Abdo cramps and fever
Giardiasis
Infection may not cause any symptoms or may cause chronic diarrhoea
Diagnosis
Salmonella: stool culture and sensitivities
Giardiasis: stool microscopy
Treatment
Conservative:
- Barrier nursing and rigorous infection control to prevent spread
- Children need to stay off school until 48 hours after symptoms have completely resolved
- Remain hydrated. Attempt fluid challenge = small volume of fluid given orally every 5-10 minutes to ensure they can tolerate it.
= If they can = go home then try dry toast
= if can’t = IV fluids may be required
- rehydration solutions (dioralyte)
Abx: only given when Px at risk of complications once the causative organism is confirmed
E.coli: avoid use of Abx to preven HUS
Shingella: azithromycin or ciprofloxacin
Campylobacter Jejuni: azithromycin or ciprofloxacin
Giardiasis: metronidazole
Yersinia Enterocolitica: Abx only necessary in severe cases
Post gastroenteritis complications
Lactose intolerance
Irritable bowel syndrome
Reactive arthritis
Guillain–Barré syndrome
