Infective gastroenteritis

Question 1

How common it is?

Answer 1

Very common, esp. in enclosed setting (hospitals, cruise ships etc)

Question 2

Who does it affect?

Answer 2

Anyone who comes into contact with the infectious agent.

Question 3

What causes it?

Answer 3

Viral:

• Rotavirus
• Norovirus
• Calcivirus
• Astrovirus
• Adenovirus
• Sapovirus

Bacterial

• Salmonella
• Shigella
• Campylobacter
• Aeromonas
• Yershinia
• E.coli (pathogenic strains)
• Clostridium (opportunistic)

Parasitic

• Giardia
• Cryptosporidium

Question 4

What risk factors are they and how can they be reduced?

Answer 4

Social factors
Immunocompromised/frail
Nutrition
Nosocomial contact

Question 5

How does it present? What symptoms should you look out for?

Answer 5

Depends on aetiology but broadly:

Diarrhoea 
- Large bowel: mucous/blood, small volume
- Small bowel: watery, large volume
- bloody generally = bacterial
- High frequency generally = bacterial
Vomiting
Fever/rigors (high with bacteria)
Abdominal pain (severe in bacterial)

Question 6

What signs may the patient have on examination?

Answer 6

Pyrexia
Tachycardia
Thready pulse
Hypotension

Question 7

Which other conditions may present similarly?

Answer 7

Appendicitis
Food poisoning
Peritonitis
Abdominal sepsis

Question 8

How would you investigate this patient?

Answer 8

.If viral cause suspected - no test necessary

Otherwise:

• Stool culture
• FBC, immunology, C.diff toxin etc
• U&Es (for dehydration)
• Blood cultures (in severely unwell)

Question 9

What would you tell the patient and how would you explain the condition to them?

Answer 9

They have an infection in their gut which is causing them to feel unwell and to have D&V. It probably got there because they touched something/someone contaminated or ate contaminated food. If viral it will go in time, if bacterial it will require treatment.

Question 10

How do you think the patient and/or family might be affected by the diagnosis? Will it affect their
ability to work/care for themselves?

Answer 10

They will probably be relieved it’s not something more serious.

It should only affect them in the short term and they should make a full recovery.
People with severe illness may take much longer to recover.

Question 11

What questions are they likely to have?

Answer 11

.How did this happen?
What can I do to stop it happening again?
Is there anything I can take to make it better?

Question 12

What treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?

Answer 12

.Viral:

• Rest
• Fluids (oral hydration therapy)
• Paracetamol
• Antiemetics

Bacterial/parasitic

• Rest
• Fluids (may require IV)
• Abx/antiprotozoals depending on agent
• Paracetamol
• Antiemetics