gastroenteritis charles e. henley d.o.,m.p.h. professor and chairman department of family medicine...
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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.