GASTROENTERITIS Charles E. Henley D.O.,M.P.H. Professor and Chairman Department of Family Medicine OSU Center for Health Sciences College of Osteopathic.

GASTROENTERITIS

Charles E. Henley D.O.,M.P.H.

Professor and Chairman

Department of Family Medicine

OSU Center for Health Sciences

College of Osteopathic Medicine

(10/2002)

Gastroenteritis, 2002

Causative Agents

Rotavirus Norwalk virus Enteric Adenovirus

Gastroenteritis, 2002

Causative Agents

Rotavirus Sporadic viral infections Most common Affects infants and young children Can be severe

Gastroenteritis, 2002

Causative Agents

NORWALK VIRUS Causes epidemic viral gastroenteritis Milder illness Usually self-limiting Affects both children and adults Community outbreaks

Gastroenteritis, 2002

Causative Agents

ENTERIC ADENOVIRUS Second most common cause of

gastroenteritis Affects younger children

Gastroenteritis, 2002

Clinical Presentation: Symptoms

Nausea / Vomiting Cramping abdominal pain

Due to excessive fluid Increased peristalsis

Absence of blood and fecal Leukocytes Key to differential with bacterial infections

Gastroenteritis, 2002

Physical Signs

Voluminous, non-bloody Stools Dehydration

Decreased urination Mental status changes Dry mucous membranes Lethargy

Gastroenteritis, 2002

History

Daycare Antibiotic Exposure Foods Hospitalize with:

Severe dehydration Abdominal tenderness Fever Bloody diarrhea

Gastroenteritis, 2002

Diagnostic Testing

Focused Bloody diarrhea? Fecal leukocytes? If non-inflammatory, no culture

Lab Tests? Viral Detection?

Test for rotavirus

Gastroenteritis, 2002

Management

Self limiting course Replace fluids and electrolytes

Oral Rehydration (ORT) Mild to moderate dehydration Commercially available ORT

Pedialyte (45 meq Na ) Ricelyte (50 meq Na )

Gastroenteritis, 2002

Management

Severe Dehydration ORT can be successful

IV fluids Shock Uremia Ileus Fluid loss > 10 ml/kg/hr

Gastroenteritis, 2002

WHO Recommendation

Recipe for ORT: 3/4 teaspoon salt 4 tablespoons sugar 1 teaspoon baking soda 1 cup orange juice 1 liter clean water

Gastroenteritis, 2002

Refeeding

ORT: continue during diarrhea Continue breast feeding Formula fed :

Lactose free Start with 1:1 dilution Full strength after 6 - 24 hours of ORT

Gastroenteritis, 2002

Refeeding

Weaned Children Avoid (24 – 48 hours):

Lactose containing foods Avoid caffeine, raw fruits

Start refeeding with: Rice, wheat noodles, bananas

Gastroenteritis, 2002

Antidiarrheal Agents

Anticholenergic agents Ineffective Contraindicated in children

Absorbents agents Kaopectate Do not change duration or fluid loss

Gastroenteritis, 2002

Antidiarrheal Agents

Antisecretory Agents Bismuth Subsalicylate (pepto-bismal )

Increases intestinal Sodium and water re-absorption

Blocks the effects of enterotoxins

Gastroenteritis, 2002

Antidiarrheal Agents

Anti-motility Agents Loperimide Lomotil Avoid in infants and children

Worsens bacterial infections

Gastroenteritis, 2002

Food Borne Illness

Incidence 6.5 million cases per year 7000 deaths

Gastroenteritis, 2002

Food Borne Illness

Etiology Bacterial

Staphlylococcus areus Salmonella typhi Clostridium difficile

Parasites Giardia lambia

Gastroenteritis, 2002

Etiology

Associated with: Undercooked meats Contaminated seafood, water Unrefrigerated foods

Treatment Resolves with supportive care Botulism

Antiserum to neurotoxin

Gastroenteritis, 2002

AIDS Patients

G.I. symptoms are common Etiology

Mycobacterium avium Adenovirus Cytomegalovirus Cryptosporidium Isospora belli Camphylobacter jejuni

Gastroenteritis, 2002

AIDS Patients

High Risk for: Salmonella Clostridium

Due to frequent antibiotic use

Gastroenteritis, 2002

AIDS Patients

Treatment Focused on treatable causes of diarrhea Alleviate morbidity

Anti-diarrheal agents Prevent fecal/oral spread of enteric

pathogens (hospitalized patients )

Gastroenteritis, 2002

Reference

Henley, C.E., Gastroenteritis. Manual of Family Practice. Taylor, Robert B., Little, Brown, 2nd Edition, 2000.