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

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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
Causative Agents
  • Rotavirus
  • Norwalk virus
  • Enteric Adenovirus
causative agents3
Causative Agents
  • Rotavirus
    • Sporadic viral infections
    • Most common
    • Affects infants and young children
    • Can be severe
causative agents4
Causative Agents
  • NORWALK VIRUS
    • Causes epidemic viral gastroenteritis
    • Milder illness
    • Usually self-limiting
    • Affects both children and adults
    • Community outbreaks
causative agents5
Causative Agents
  • ENTERIC ADENOVIRUS
    • Second most common cause of gastroenteritis
    • Affects younger children
clinical presentation symptoms
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
physical signs
Physical Signs
  • Voluminous, non-bloody Stools
  • Dehydration
    • Decreased urination
    • Mental status changes
    • Dry mucous membranes
    • Lethargy
history
History
  • Daycare
  • Antibiotic Exposure
  • Foods
  • Hospitalize with:
    • Severe dehydration
    • Abdominal tenderness
    • Fever
    • Bloody diarrhea
diagnostic testing
Diagnostic Testing
  • Focused
    • Bloody diarrhea?
    • Fecal leukocytes?
    • If non-inflammatory, no culture
  • Lab Tests?
  • Viral Detection?
    • Test for rotavirus
management
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 )
management11
Management
  • Severe Dehydration
    • ORT can be successful
  • IV fluids
    • Shock
    • Uremia
    • Ileus
    • Fluid loss > 10 ml/kg/hr
who recommendation
WHO Recommendation
  • Recipe for ORT:
    • 3/4 teaspoon salt
    • 4 tablespoons sugar
    • 1 teaspoon baking soda
    • 1 cup orange juice
    • 1 liter clean water
refeeding
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
refeeding14
Refeeding
  • Weaned Children
    • Avoid (24 – 48 hours):
      • Lactose containing foods
      • Avoid caffeine, raw fruits
    • Start refeeding with:
      • Rice, wheat noodles, bananas
antidiarrheal agents
Antidiarrheal Agents
  • Anticholenergic agents
    • Ineffective
    • Contraindicated in children
  • Absorbents agents
    • Kaopectate
    • Do not change duration or fluid loss
antidiarrheal agents16
Antidiarrheal Agents
  • Antisecretory Agents
    • Bismuth Subsalicylate (pepto-bismal )
      • Increases intestinal Sodium and water re-absorption
      • Blocks the effects of enterotoxins
antidiarrheal agents17
Antidiarrheal Agents
  • Anti-motility Agents
    • Loperimide
    • Lomotil
    • Avoid in infants and children
      • Worsens bacterial infections
food borne illness
Food Borne Illness
  • Incidence
    • 6.5 million cases per year
    • 7000 deaths
food borne illness19
Food Borne Illness
  • Etiology
    • Bacterial
      • Staphlylococcus areus
      • Salmonella typhi
      • Clostridium difficile
    • Parasites
      • Giardia lambia
etiology
Etiology
  • Associated with:
    • Undercooked meats
    • Contaminated seafood, water
    • Unrefrigerated foods
  • Treatment
    • Resolves with supportive care
    • Botulism
      • Antiserum to neurotoxin
aids patients
AIDS Patients
  • G.I. symptoms are common
  • Etiology
    • Mycobacterium avium
    • Adenovirus
    • Cytomegalovirus
    • Cryptosporidium
    • Isospora belli
    • Camphylobacter jejuni
aids patients22
AIDS Patients
  • High Risk for:
    • Salmonella
    • Clostridium
      • Due to frequent antibiotic use
aids patients23
AIDS Patients
  • Treatment
    • Focused on treatable causes of diarrhea
    • Alleviate morbidity
      • Anti-diarrheal agents
    • Prevent fecal/oral spread of enteric pathogens (hospitalized patients )
reference
Reference
  • Henley, C.E., Gastroenteritis. Manual of Family Practice. Taylor, Robert B., Little, Brown, 2nd Edition, 2000.