Viral gastroenteritis Flashcards
Viral gastroenteritis is an acute inflammation of the lining of the stomach and small intestine, resulting from viral infection. What is the incidence of VG?
1 - 50 cases per 100,000
2 - 500 cases per 100,000
3 - 5000 cases per 100,000
4 - 50,000 cases per 100,000
3 - 5000 cases per 100,000
Affects males and females equally
The most common cause of acute diarrhoea in the general population contracted by person to person contact
Viral gastroenteritis (VG) can occur at any age, but what is the peak age that VG occurs?
1 - 1-4 y/o
2 - 10-20 y/o
3 - 30-40 y/o
4 - >65 y/o
3 - 30-40 y/o
In children most common age is 6-24 months
Most common in winter and spring
All of the following organisms can cause viral gastroenteritis (VG). Which of the following is the most common cause of VG in children and adults?
1 - rotavirus
2 - sapovirus
3 - novovirus
4 - adenovirus
3 - novovirus
All of the following organisms can cause viral gastroenteritis (VG). Which of the following used to be the most common cause of VG in children?
1 - rotavirus
2 - sapovirus
3 - novovirus
4 - adenovirus
1 - rotavirus
- causes more prolonged infection when compared to other viruses
Typically all children in the UK will have VG before their 5th birthday
Bacteria and parasites can also cause this
Which of the following viruses is commonly associated with outbreaks in nurseries and paediatric wards causing viral gastroenteritis?
1 - rotavirus
2 - sapovirus
3 - novovirus
4 - adenovirus
4 - adenovirus
Typically called enteric adenovirus
Which of the following is NOT a common risk factor for developing viral (VG) gastroenteritis?
1 - exposure to contaminated food and 2 2 - exposure to contaminated water
3 - close contact with an infected persons
4 - good hygiene
5 - immunocompromised
4 - good hygiene
Typically poor hygiene causes VG
Which of the following does NOT typically occur during viral gastroenteritis?
1 - ingestion of virus
2 - virus infects enterocytes throughout whole of the GIT
3 - virus replicates in enterocytes
4 - virus disrupts absorption and secretion and electrolytes (specifically chloride) flood into lumen
5 - viral enterotoxins secreted
6 - malabsorption and osmotic diarrhoea
2 - virus infects enterocytes throughout whole of the GIT
Typically only affects upper GI
Viral gastroenteritis typically self limiting. How long does it normally last for?
1 - <24h
2 - <72h
3 - <7 days
4 - <14 days
4 - <14 days
In viral gastroenteritis, is a high or low fever common?
- low grade fever
Bacteria typically cause a high grade fever
Acute diarrhoea is a common symptom in viral gastroenteritis. How many times must an individual pass stools to be diagnosed with acute diarrhoea?
1 - >3/day
2 - >5/day
3 - >7/week
4 - >10/week
1 - >3/day
Typically watery in nature
Acute diarrhoea is a common symptom in viral gastroenteritis. Does this present rapidly or have an insidious nature?
- rapid onset
In acute diarrhoea, if blood is present in stool in viral gastroenteritis, is this likely to be due to bacteria or a virus?
- bacteria
If blood in the stool suspect Shiga-toxin producing E-coli or Campylobacter infection
In addition to acute diarrhoea, a common symptom in viral gastroenteritis, which of the following symptoms is NOT common?
1 - blood in stool
2 - vomiting and nausea
3 - abdominal pain
4 - mild fever
5 - mucus
1 - blood in stool
- typically occurs if cause is bacterial, rather than viral.
Mucus is more common in bacterial, but can also present in viral
A short viral prodrome may occur prior to any symptoms of viral gastroenteritis
A common clinical finding in patients with viral gastroenteritis is dehydration. Which of the following is NOT a sign of dehydration?
1 - dry mucous membranes
2 - tachycardia
3 - hypertension
4 - thin, thready pulse
5 - reduced urine output
6 - reduced skin turgor and sunken eyes
3 - hypertension
Typically causes hypotension
A common clinical finding in patients with viral gastroenteritis is dehydration. Which of the following does NOT increase the risk of dehydration?
1 -year of age
2 - low birth weight infants
3 - ≥ 6 diarrhoeal stools in 24hours
4 - ≥ 3 vomiting in the last 24hours.
5 - breastfeeding infants
6 - malnutrition
7 - immunosuppression.
5 - breastfeeding infants
Stopping breastfeeding is a risk factor and a major concern
Which of the following is most effective when diagnosing viral gastroenteritis?
1 - U&Es
2 - FBC
3 - Clinical diagnosis
4 - stool culture
3 - Clinical diagnosis
- examination and history
Stool culture is not common, unless the following are present:
- Persistent diarrhoea >14 days
- Blood or pus in the stool
- Suspicion of non-viral gastroenteritis
- History of recent hospitalisation and antibiotic therapy
- Recent foreign travel history
All of the following could be a differential for viral gastroenteritis, but which is least likely?
1 - Bacterial gastroenteritis
2 - Food poisoning
3 - Clostridium difficile infection
4 - IBD
5 - Cholecystitis
6 - IBS
7 - Coeliac disease
8 - Hyperthyroidism
5 - Cholecystitis
Viral gastroenteritis is typically self-limiting and lasts <14 days. Are patients normally treated at home or admitted to hospital?
- managed at home
Plenty of fluids and non-fatty meals and advise on good hygiene to reduce spread
In a patient who has been identified as not being dehydrates with viral gastroenteritis they should be advised to do all of the following except which one?
1 - drink fruit juices and carbonated drinks to help increase glucose
2 - continue breastfeeding
3 - increase overall fluid intake
4 - oral rehydration solution as supplement fluid if at risk of dehydration
1 - drink fruit juices and carbonated drinks to help increase glucose
These can worsen diarrhoea and therefore dehydration
Oral rehydration solution contains glucose and salts (Na+ and K+Cl-)
In a patient who has been identified as clinically dehydrates with viral gastroenteritis they should be advised to do all of the following except which one?
1 - give fluid deficit replacement (based on 5% bodyweight)
2 - give maintenance fluids
3 - continue breastfeeding
3 - always use a nasogastric tube
4 - supplement with oral rehydration solution
3 - always use a nasogastric tube
May be used if child is vomitting, but not always
If a patient goes into shock due to dehydration, how much balanced crystalloids or 0.9% saline solution should they be given?
1 - 1ml/kg boluses
2 - 10ml/kg boluses
3 - 25ml/kg boluses
4 - 50ml/kg boluses
2 - 10ml/kg boluses
Do not use dextrose-based solutions for volume replacement as this can cause hyponatraemia and hyperglycaemia, which may worsen neurological outcome.
The formula for fluid maintenance is for a child weighing <10kg is:
<10kg: 100 mL/kg fluids per day
What is the fluid maintenance that would be needed for a 6.4kg child?
1 - 6.4ml/kg fluids per day
2 - 64mL/kg fluids per day
3 - 640mL/kg fluids per day
4 - 6400mL/kg fluids per day
3 - 650mL/kg fluids per day
Weight = 6.4kg
Fluid - 100ml per kg
6.4 x 100 = 640ml/day
So 640ml over 24h = 27ml/hour or 0.45ml/min
The formula for fluid maintenance is for a child weighing between 10-20kg is:
10–20kg: 1000 mL + 50 mL/kg/day for each kg over 10kg
What is the fluid maintenance that would be needed for a 18.5kg child?
1 - 14.25ml/kg fluids per day
2 - 142.5mL/kg fluids per day
3 - 1425mL/kg fluids per day
4 - 14,250mL/kg fluids per day
3 - 1425mL/kg fluids per day
Weight = 18.5kg
Fluid - 1000ml for first 10kg and then 50ml for each kg up to 10kg.
1000ml + (8.5 x 50) = 1425ml/day
So 1425ml over 24h = 24ml/hour or 0.99ml/min
The formula for fluid maintenance is for a child weighing >20kg is:
1500 mL + 20 mL/kg for each kg over 20 kg per day
What is the fluid maintenance that would be needed for a 33kg child?
1 - 17.60ml/kg fluids per day
2 - 176.0mL/kg fluids per day
3 - 1760mL/kg fluids per day
4 - 17,600mL/kg fluids per day
3 - 1760mL/kg fluids per day
Weight = 33kg
Fluid - 1500 for first 20kg and then 20ml for each kg after 20kg
1500ml + (13 x 20) = 1760ml/day
So 1760ml over 24h = 29ml/hour or 1.2ml/min
If a patient is dehydrated in paediatrics, we need to calculate their fluid deficit. This can be performed using the following:
Fluid deficit (mL) = % dehydration x weight (kg) x 10
Step 1 = Previous weight - current weight
Step 2 = (change in weight/previous weight) x 100% = % dehydration
Step 3 = (% dehydration x current weight) x 10
If a child weighed 12kg before and now weight 11.5kg, what is their fluid deficit?
1 - 4714ml
2 - 474.1ml
3 - 47.41ml
4 - 4.742ml
2 - 474.1ml
Fluid deficit:
Previous weight = 12kg
Current weight = 11.5kg
Weight different = 0.5kg
- (0.5/12kg) x 100% = 4.1% dehydration
- (4.1 x 11.5) x 10 = 471.5ml
Maintenance fluid =
- 1000ml + (1.5 x 50) = 1075ml
Total fluid prescription is 1075 + 471.5 = 1547ml/day
Or 26ml/h or 1.1ml/min
Weight is typically used for maintenance fluid and fluid deficits. However, if the weight is not available how much deficit should be presumed in a patient who is clinical dehydrated?
1 - 5%
2 - 5-10%
3 - >10%
4 - 15-20%
2 - 5-10%
0 no clinically detectable dehydration <5% deficit
- clinical dehydration( 5%–10% deficit)
- shock (usually >10% deficit)
If a patient is suspected as having viral gastroenteritis, we can perform all of the following, except which one is typically not performed?
1 - echocardiogram
2 - ABG or VBG
3 - U&Es
4 - CRP
5 - FBC
6 - Stool
1 - echocardiogram
- ABG or VBG would most likely show metabolic acidosis
- U&Es would show Na+ abnormalities, hypokalaemia and raised urea
- CRP may be raised due to infection
- FBC may be raised due to leukocytosis
- Stool may rule out bacterial cause
Viral gastroenteritis is typically self-limiting and lasts <14 days. However, if the patient meets any of the following criteria, EXCEPT which one, they may need fluid resuscitation?
1 - Systolic blood pressure >100
2 - Heart rate >90
3 - Cool peripheries
4 - Respiratory rate >20
5 - PEWS score >5
1 - Systolic blood pressure >100
This would normally be below 100 if dehydrated
If needed consider:
- Fluid resuscitation
- Hospital admission
- Enable rehydration and electrolyte replacement
- Prevent spread of infection
All of the following may need to be admitted to hospital, EXCEPT which one?
1 - unable to to maintain oral intake due to vomiting
2 - elderly individuals >60 years old, who are more at risk of severe dehydration
3 - Abdominal tenderness
4 - Diarrhoea lasting > 3days or more
4 - Diarrhoea lasting > 3days or more
Typically, it is if the diarrhoea has lasted >10 days
Are antibiotics and anti-virals typically recommended in vial gastroenteritis?
- not recommended
Zinc supplementation may help reduce severity in third world countries
Following infection with viral gastroenteritis, when can patient be allowed back to work after vomiting and diarrhoea have stopped?
1 - 12h
2 - 48h
3 - 1 week
4 - 2 weeks
2 - 48h
There are lots of complications of viral gastroenteritis. Which of the following is the least likely?
1 - dehydration and shock
2 - AKI
3 - lactose intolerance
4 - dehydration and electrolyte disturbances
5 - peptic ulcers
Dehydration and electrolyte disturbances
Lactose intolerance caused by inflammation to microvilli reducing reducing the expression of lactase enzymes.
Normal diet after an episode of diarrhoea results in a return of foul-smelling loose stool, excessive wind, nappy rash etc.
Management: Restart ORT/lactose free milk
May need up to 8weeks to heal
