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

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 Key to differential with bacterial infections

Absence of blood and fecal Leukocytes

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 Mild to moderate dehydration Commercially available ORT
Pedialyte (45 meq Na ) Ricelyte (50 meq Na )

Oral Rehydration (ORT)

Gastroenteritis, 2002

Management

Severe Dehydration

ORT can be successful Shock Uremia Ileus Fluid loss > 10 ml/kg/hr

IV fluids

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 Kaopectate Do not change duration or fluid loss

Absorbents agents

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

Resolves with supportive care Botulism

Treatment

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.

Gastroenteritis, 2002