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GASTROENTERITIS

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Key to differential with bacterial infections. Gastroenteritis, 2002. Physical Signs ... Worsens bacterial infections. Gastroenteritis, 2002. Food Borne ... – PowerPoint PPT presentation

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Title: GASTROENTERITIS


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 gt 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 11 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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