Acute Gastroenteritis

ACUTE GASTROENTERITIS

ACUTE GASTROENTERITIS

1INTRODUCTIONGastroenteritis, often called the "stomach flu," is a common and normally short-lived illness characterized by diarrhea and low-grade fever, cramps, nausea, and vomiting.

Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract). The most common symptoms of gastroenteritis arediarrhea,nausea, andcrampy abdominal pain, vomiting.

2INTRODUCTIONOn a global scale, gastroenteritis is a massive health problem. About 5 million people die each year, mainly young children in underdeveloped countries. Most deaths are due to dehydration, inadequate fluid replacement and circulatory collapse.

DEFINITION OF TERMSGASTROENTERITISGastroenteritis is inflammation of the lining of the stomach and small and large intestines.B. BOBORYGMIRumbling sounds caused by gas moving through the intestines, commonly referred to as stomach "growling".

DEFINITION OF TERMSC. TENESMUSStraining to defecate or urinate.D. DIARRHEADiarrhea describes loose, watery stools that occur more frequently than usual.E. DYSENTERYDysenteryis diarrhea which contains blood.Rectal tenesmus (Latin, from Greek teinesmos, from teinein to stretch, strain) is a feeling of incomplete defecationMild 2-3 stools /dayModerate - 10 stools a day5

DEFINITION OF TERMSF. VIRUSA virus is a small infectious agent that replicates only inside the living cells of other organisms.G. BACTERIAMicroorganisms comprising one of the three domains of living organisms. They are prokaryotic, unicellular, and either free living in soil or water or parasites of plants or animals.

Causative agent that causes infectious disease6DEFINITION OF TERMSH. PROTOZOAProtozoa are a diverse group of unicellular eukaryotic organisms, many of which are motile.I. PERISTALSISPeristalsis are a series of muscle contractions that occur in your digestive tract.Peristalsis are a series of muscle contractions that occur in your digestive tract.7DEFINITION OF TERMSJ. SALMONELLA A bacterium that occurs mainly in the intestine, especially a serotype causing food poisoning.

ETIOLOGYVIRUSA. RotavirusIs the most common cause of severe, dehydrating diarrhea among young children. It usually affects those between the ages of 3 months and 15 months. Rotavirus is highly contagious.

Rotavirus is a viral infection that can cause symptoms of being sick (vomiting) and diarrhoea.9ETIOLOGYB. Norovirus Most commonly infects older children and adults. Norovirus infection can cause the sudden onset of severe vomiting and diarrhea. The virus is highly contagious and commonly spread through food or water that is contaminated by fecal matter during preparation

Noroviruses are transmitted directly from person to person and indirectly via contaminated water and food.Noroviruses are a group of viruses that cause inflammation of the stomach and large intestine lining (gastroenteritisNorovirus is a genus of genetically diverse single-stranded RNA, non-enveloped viruses in the Caliciviridae family.[1] The known viruses in the genus are all considered to be the variant strains of a single species called Norwalk virus. The viruses are transmitted by fecally contaminated food or water, by person-to-person contact,[2] and via aerosolization of the virus and subsequent contamination of surfaces.[310ETIOLOGYC. Astrovirus Can infect people of all ages but usually infects infants and young children. Infection is most common in the winter and is spread by fecal-oral transmission.

astroviruses have now been isolated from numerous mammalian animal species (and are classified as genus Mammoastrovirus) and from avian species such as ducks, chickens, and turkey poults 11ETIOLOGYBACTERIAA. Salmonella Salmonellosis is a form of gastroenteritis caused by the germ (bacterium) Salmonella. Salmonellosis can affect anyone. However, most cases occur in children and young adults

Salmonellae are found worldwide in both cold-blooded and warm-blooded animals, and in the environment. They cause illnesses such as typhoid fever, paratyphoid fever, and food poisoning.[1]12ETHIOLOGYB. Campylobacter Are most frequently acquired from undercooked poultry. Campylobacter is occasionally transmitted by dogs or cats with diarrhea

CampylobacterIt is frequently found in raw meat, particularly chicken, and thus is a significant cause of food poisoning due to handling raw meat or undercooking it. 13ETHIOLOGYC. Escherichia Coli Is a Gram-negative, facultatively anaerobic, rod-shaped bacterium of the genus Escherichia that is commonly found in the lower intestine of warm-blooded organisms

bacteria normally live in the intestines of healthy people and animals14ETHIOLOGYD. Clostridium DifficileAlso known as pseudomembranous colitis is a bacterial dysentery commonly seen in clients who have been receiving large doses of antibiotics.Primary risk factors are exposure to antibiotics, exposure to a healthcare environment, and acid-suppressing medications.are found throughout the environment in soil, air, water, human and animal feces, and food products15ETHIOLOGYPARASITICA. Gardia Stick to or invade the lining of the intestine and cause nausea, vomiting, diarrhea, and a general sick feeling

Giardia infection can occur through ingestion of dormant microbial cysts in contaminated water, food, or by the faecal-oral route (through poor hygiene practices). The cyst can survive for weeks to months in cold water,[5] so can be present in contaminated wells and water systems, especially stagnant water sources, such as naturally occurring ponds, storm water storage systems, and even clean-looking mountain streams16ETHIOLOGYB. Cryptosporidium Causes watery diarrhea that is sometimes accompanied by abdominal cramps, nausea, and vomiting. The resulting infection, called cryptosporidiosis

TRANSMISSION1.Fecal-Oral RouteTransmission of infection occurs when infectious particles from feces are ingested through the mouth2. Person-person

PATHOPHYSIOLOGYCLINICAL MANIFESTATIONS Diarrhea Nausea Vomiting Anorexia Abdominal Pain Cramping Boborygmi Fever Tenesmus Headache

COMPLICATIONSDEHYDRATIONThis is the most common complication. It occurs if the water and salts that are lost in your stools, or when you vomit, are not replaced by your drinking adequate fluids. If you can manage to drink plenty of fluids then dehydration is unlikely to occur, or is only likely to be mild, and will soon recover as you drink. Severe dehydration can lead to a drop in your blood pressure. This can cause reduced blood flow to your vital organs. If dehydration is not treated, kidney failure may also develop.Dehydration- hemoconcentration21COMPLICATIONSMildModerateSevereWeight loss Up to 5% 6-10% More than 10% Appearance Active, alert Irritable, alert, thirsty Lethargic, looks sick Capillary filling (compared to your own) Normal Slightly delayed Delayed Pulse Normal Fast, low volume Very fast, thready Respiration Normal Fast Fast and deep Blood pressure Normal Normal or low Orthostatic hypotension Very low10 kg child who is 5% dehydrated will weigh 9.5 kg. A 10 kg child who is 10% dehydrated will weigh 9 kg. A 5 kg child who is 10% dehydrated will weigh 4.5 kg.22COMPLICATIONSMucous memb. Moist Dry Parched Tears Present Less than expected Absent Eyes Normal Normal Sunken Pinched skin Springs back Tents briefly Prolonged tenting Fontanel (infant sitting)Normal Sunken slightly Sunken significantly Urine flow Normal Reduced Severely reduced

COMPLICATIONS2. Spread of Infection To other parts of your body such as your bones, joints, or the meninges that surround your brain and spinal cord. This is rare. If it does occur, it is more likely if gastroenteritis is caused by Salmonella spp. infection.

COMPLICATIONS3.Hemolytic uremic syndrome Is another potential complication. It is rare and is usually associated with gastroenteritis caused by a certain type of E. coli infection. It is a serious condition where there is anaemia, a low platelet count in the blood, and kidney failure. It is more common in children. If recognised and treated, most people recover well. The presence of blood or leukocytes in stool is a strong indicator of inflammatory diarrhea.

Hemolytic uremic syndrome (HUS) is a condition that results from the abnormal premature destruction of red blood cells. Once this process begins, the damaged red blood cells start to clog the filtering system in the kidneys, which may eventually cause the life-threatening kidney failure associated with hemolytic uremic syndrome. Most cases of hemolytic uremic syndrome develop in children after two to 14 days of diarrhea often bloody due to infection with a certain strain of Escherichia coli (E. coli). Adults also may develop hemolytic uremic syndrome after an E. coli infection, but the cause also may be certain medications, other types of infections, pregnancy or it may be unknown.

26MEDICAL MANAGEMENTLABORATORY/DIAGNOSTIC TESTStool cultureThe presence of blood or leukocytes in stool is a strong indicator of inflammatory diarrhea.This test detects and screens for certain microorganisms which cause intestinal diseases from a culture of stool[1]. This test is used when infectious gastroenteritis is suspectedFor a stool culture, a stool sample is collected in a clean container and placed under conditions that allow bacteria or other organisms to grow. The type of infection is identified by noting the appearance of the growth, by performing chemical tests on the stool sample, and by looking at the sample under a microscope27MEDICAL MANAGEMENTB. Serum ElectrolytesTo monitor for electrolyte imbalancesHypernatremiaHyperkalemia

Sodium ImbalanceSodium is one of the most important electrolytes affected by dehydration. Gastroenteritis can cause hypernatremia, or high sodium levels in the blood stream, when the body loses more water than electrolytes, concentrating the amount of sodium. On the other hand, hyponatremia, or low sodium levels, results when the body loses more sodium than water, especially in cases of severe vomiting and diarrhea. Signs of hyponatremia include headache, confusion and lethargy. High sodium causes thirst, confusion and seizures.Potassium ImbalancePotassium is mostly found inside the body's cells, so small changes in the potassium level in the bloodstream can have a significant impact in a person with gastroenteritis. High potassium can cause dangerous arrhythmias, or abnormal heart rhythms. In particular, it can cause ventricular fibrillation, a condition in which the heart quivers instead of beats, thereby decreasing its ability to deliver blood to the brain and the body. Low potassium usually causes milder symptoms, like muscle cramps, fatigue and constipation

28MEDICAL MANAGEMENTC.BUNTo evaluate kidney functionD.CreatinineTo assess kidney function

to evaluate hydration and acid-base status in patients who appear seriously illA BUN test is done to see how well your kidneys are working. If your kidneys are not able to remove urea from the blood normally, your BUN level rises. Creatinine has been found to be a fairly reliable indicator of kidney function. Elevated creatinine level signifies impaired kidney function or kidney disease29

MEDICAL MANAGEMENTA.Oral and IV RehydrationOral rehydration has been largely responsible for the tremendous decrease in the death rate in underdeveloped countries from infectious diarrhea, including cholera. For pediatric patients, administer 20 mL/kg of isotonic sodium chloride solution initially for resuscitation.

hree good fluid solutions for sick children include:FluidAlternative namesUses0.9% NaClNormal salineInitial bolusesReplacement of deficitReplacement of losses0.9% NaCl with 5% Glucose* ORNormal saline with glucoseMaintenance0.45% NaCl with 5% Glucose*1/2 Normal saline with glucoseMaintenance30

MEDICAL MANAGEMENTOral Rehydration Therapy (ORT)is the process of replacing essential body fluids and salts that a child loses in critical quantities during attacks of diarrhoea. The treatment consists of common salt and sugar mixed in one liter of clean drinking water given to the child by mouth.

All children on IV fluids should be weighed prior to the commencement of therapy, and daily afterwards. Ensure you request this on the treatment orders.Children with ongoing dehydration/ongoing losses may need 6 hourly weights to assess hydration statusAll children on IV fluids should have serum electrolytes and glucose checked before commencing the infusion (typically when the IV is placed) and again within 24 hours if IV therapy is to continue.For more unwell children, check the electrolytes and glucose 4-6 hours after commencing, and then according to results and the clinical situation but at least daily.Pay particular attention to the serum sodium on measures of electrolytes. If 145mmol/L (or rising significantly on repeat measures) see Hypernatraemia GuidelineChildren on iv fluids should have a fluid balance chart documenting input, ongoing losses and urine output

31NUTRITIONAL MANAGEMENTIt is recommended that breast-fed infants continue to be nursed in the usual fashion, and that formula-fed infants continue their formula immediately after rehydration with ORT.TheBRAT diet(bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.32MEDICAL MANAGEMENTB. AntiemeticsAntiemeticmedications may be helpful for treating vomiting in children.Ondansetronhas some utility, with a single dose being associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.Metoclopramidemight also be helpful. However, the use of ondansetron might possibly be linked to an increased rate of return to hospital in childrenOdansetron is a selective 5-HT3-receptor antagonist that blocks serotonin both peripherally and centrally. It prevents nausea and vomiting. Chemotherapy-Induced Nausea & VomitingProphylaxisPO12 years: 8 mg started 30 min before chemotherapy, then q12hr for 1-2 days after chemotherapy, or single dose of 24 mgIV