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GASTROENTERITIS

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). Causative Agents. Rotavirus Norwalk virus Enteric Adenovirus. Causative Agents. Rotavirus

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GASTROENTERITIS

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  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 > 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 1:1 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.

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