GASTROENTERITIS

1
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)

2
Causative Agents

• Rotavirus
• Norwalk virus
• Enteric Adenovirus

3
Causative Agents

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

4
Causative Agents

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

5
Causative Agents

• ENTERIC ADENOVIRUS
• Second most common cause of gastroenteritis
• Affects younger children

6
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

7
Physical Signs

• Voluminous, non-bloody Stools
• Dehydration
• Decreased urination
• Mental status changes
• Dry mucous membranes
• Lethargy

8
History

• Daycare
• Antibiotic Exposure
• Foods
• Hospitalize with
• Severe dehydration
• Abdominal tenderness
• Fever
• Bloody diarrhea

9
Diagnostic Testing

• Focused
• Bloody diarrhea?
• Fecal leukocytes?
• If non-inflammatory, no culture
• Lab Tests?
• Viral Detection?
• Test for rotavirus

10
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 )

11
Management

• Severe Dehydration
• ORT can be successful
• IV fluids
• Shock
• Uremia
• Ileus
• Fluid loss gt 10 ml/kg/hr

12
WHO Recommendation

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

13
Refeeding

• ORT continue during diarrhea
• Continue breast feeding
• Formula fed
• Lactose free
• Start with 11 dilution
• Full strength after 6 - 24 hours of ORT

14
Refeeding

• Weaned Children
• Avoid (24 48 hours)
• Lactose containing foods
• Avoid caffeine, raw fruits
• Start refeeding with
• Rice, wheat noodles, bananas

15
Antidiarrheal Agents

• Anticholenergic agents
• Ineffective
• Contraindicated in children
• Absorbents agents
• Kaopectate
• Do not change duration or fluid loss

16
Antidiarrheal Agents

• Antisecretory Agents
• Bismuth Subsalicylate (pepto-bismal )
• Increases intestinal Sodium and water
  re-absorption
• Blocks the effects of enterotoxins

17
Antidiarrheal Agents

• Anti-motility Agents
• Loperimide
• Lomotil
• Avoid in infants and children
• Worsens bacterial infections

18
Food Borne Illness

• Incidence
• 6.5 million cases per year
• 7000 deaths

19
Food Borne Illness

• Etiology
• Bacterial
• Staphlylococcus areus
• Salmonella typhi
• Clostridium difficile
• Parasites
• Giardia lambia

20
Etiology

• Associated with
• Undercooked meats
• Contaminated seafood, water
• Unrefrigerated foods
• Treatment
• Resolves with supportive care
• Botulism
• Antiserum to neurotoxin

21
AIDS Patients

• G.I. symptoms are common
• Etiology
• Mycobacterium avium
• Adenovirus
• Cytomegalovirus
• Cryptosporidium
• Isospora belli
• Camphylobacter jejuni

22
AIDS Patients

• High Risk for
• Salmonella
• Clostridium
• Due to frequent antibiotic use

23
AIDS Patients

• Treatment
• Focused on treatable causes of diarrhea
• Alleviate morbidity
• Anti-diarrheal agents
• Prevent fecal/oral spread of enteric pathogens
  (hospitalized patients )

24
Reference

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