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Acute Gastroenteritis
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Acute Gastroenteritis

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Acute Gastroenteritis

Acute Gastroenteritis

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Acute Gastroenteritis Acute Gastroenteritis Presentation Transcript

    • Acute Gastroenteritis
    • Diarrhea associated with nausea and vomiting is referred to as gastroenteritis
  • Pathophysiology
    • cause diarrhea by adherence, mucosal invasion, enterotoxin production, and/or cytotoxin production
    • result in increased fluid secretion and/or decreased absorption
    • produces an increased luminal fluid content that cannot be adequately reabsorbed
    • leading to dehydration and the loss of electrolytes and nutrients
  • Diarrheal may be classified:
    • Osmotic - increase in the osmotic load in the intestinal lumen, excessive intake/diminished absorption
    • Inflammatory/mucosal - the mucosal lining of the intestine is inflamed
    • Secretory - increased secretory activity occurs
    • Motile, caused by intestinal motility disorders
    • small intestine is the prime absorptive surface
    • Colon: absorbs additional fluid, transforming a liquid fecal stream in the cecum to well-formed solid stool in the rectosigmoid
    • Enterocyte invasion is the preferred method by which microbes such as Shigella and Campylobacter organisms and enteroinvasive E coli cause destruction and inflammatory diarrhea
    • Salmonella & Yersinia species invade cells but do not cause cell death.
    • invade the bloodstream across the lamina propria and cause enteric fever such as typhoid
    • Normally, more than 100,000 E coli are required to cause disease
    • Only 10 Entamoeba or Giardia cysts may suffice to do the same. Some organisms (eg, V cholera, enterotoxigenic E coli ) produce proteins that aid their adherence to the intestinal wall, thereby displacing the normal flora and colonizing the intestinal lumen
    • nausea, a sudden onset of vomiting, moderate diarrhea, headache, fever (~50%), chills, and myalgia and will last 12-60 hours
    • colonic involvement is usually associated with tenesmus and pain in either of the lower quadrants or the lower back, whereas jejunoileal infection may result in periumbilical pain
  • History:
    • should assess the onset, frequency, quantity, and character of vomiting and diarrhea
    • Recent oral intake, including breast milk and other fluids and food; urine output; wt before illness; and associated symptoms, including fever or changes in mental status should be noted
  • physical examination
    • degree of hydration/percentage deficit: <3%, none;
    • 3-6%, mild;
    • 6-9%,moderate;
    • >10%, severe
    • accurate body wt must be obtained, with temperature, heart rate, respiratory rate, and blood pressure
    • Rectal examination may reveal abscesses, fistulae, and fissures, which may indicate inflammatory bowel disease
    • Hydration and nutritional status
    • Diminished skin turgor, weight loss, resting hypotension and tachycardia, dry mucus membranes, decreased frequency of urination, changes in mental status, and orthostasis can be used to gauge dehydration
    • general condition of the patient should be assessed
    • The appearance of the eyes should be noted, the degree to which they are sunken and presence or absence of tears
    • The condition of the lips, mouth, and tongue will yield clues regarding the degree of dehydration
    • Deep respirations can be indicative of metabolic acidosis
    • Faint/absent bowel sounds can indicate hypokalemia
  • Clinical Management in the Hospital :
    • Indicated for children if :
    • caregivers cannot provide adequate care at home;
    • difficulties in administrating ORT: intractable vomiting, ORS refusal, or inadequate ORS intake;
    • worsening diarrhea or dehydration despite adequate volumes;
    • severe dehydration (>9% of body weight) exists;
    • social or logistical concerns
    • young age, unusual irritability or drowsiness, progressive course of symptoms, or uncertainty of diagnosis exist that might indicate a need for close observation.
    • Thank You…