1 / 24

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

Sophia
Download Presentation

GASTROENTERITIS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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.

More Related