Acute Gastroenteritis


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Acute Gastroenteritis

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Acute Gastroenteritis

  1. 1. <ul><li>Acute Gastroenteritis </li></ul><ul><li>Diarrhea associated with nausea and vomiting is referred to as gastroenteritis </li></ul>
  2. 2. Pathophysiology <ul><li>cause diarrhea by adherence, mucosal invasion, enterotoxin production, and/or cytotoxin production </li></ul><ul><li>result in increased fluid secretion and/or decreased absorption </li></ul><ul><li>produces an increased luminal fluid content that cannot be adequately reabsorbed </li></ul><ul><li>leading to dehydration and the loss of electrolytes and nutrients </li></ul>
  3. 3. Diarrheal may be classified: <ul><li>Osmotic - increase in the osmotic load in the intestinal lumen, excessive intake/diminished absorption </li></ul><ul><li>Inflammatory/mucosal - the mucosal lining of the intestine is inflamed </li></ul><ul><li>Secretory - increased secretory activity occurs </li></ul><ul><li>Motile, caused by intestinal motility disorders </li></ul>
  4. 4. <ul><li>small intestine is the prime absorptive surface </li></ul><ul><li>Colon: absorbs additional fluid, transforming a liquid fecal stream in the cecum to well-formed solid stool in the rectosigmoid </li></ul><ul><li>Enterocyte invasion is the preferred method by which microbes such as Shigella and Campylobacter organisms and enteroinvasive E coli cause destruction and inflammatory diarrhea </li></ul>
  5. 5. <ul><li>Salmonella & Yersinia species invade cells but do not cause cell death. </li></ul><ul><li>invade the bloodstream across the lamina propria and cause enteric fever such as typhoid </li></ul><ul><li>Normally, more than 100,000 E coli are required to cause disease </li></ul><ul><li>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 </li></ul>
  6. 6. <ul><li>nausea, a sudden onset of vomiting, moderate diarrhea, headache, fever (~50%), chills, and myalgia and will last 12-60 hours </li></ul><ul><li>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 </li></ul>
  7. 7. History: <ul><li>should assess the onset, frequency, quantity, and character of vomiting and diarrhea </li></ul><ul><li>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 </li></ul>
  8. 8. physical examination <ul><li>degree of hydration/percentage deficit: <3%, none; </li></ul><ul><li>3-6%, mild; </li></ul><ul><li>6-9%,moderate; </li></ul><ul><li>>10%, severe </li></ul><ul><li>accurate body wt must be obtained, with temperature, heart rate, respiratory rate, and blood pressure </li></ul>
  9. 9. <ul><li>Rectal examination may reveal abscesses, fistulae, and fissures, which may indicate inflammatory bowel disease </li></ul><ul><li>Hydration and nutritional status </li></ul><ul><li>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 </li></ul>
  10. 10. <ul><li>general condition of the patient should be assessed </li></ul><ul><li>The appearance of the eyes should be noted, the degree to which they are sunken and presence or absence of tears </li></ul><ul><li>The condition of the lips, mouth, and tongue will yield clues regarding the degree of dehydration </li></ul><ul><li>Deep respirations can be indicative of metabolic acidosis </li></ul><ul><li>Faint/absent bowel sounds can indicate hypokalemia </li></ul>
  11. 11. Clinical Management in the Hospital : <ul><li>Indicated for children if : </li></ul><ul><li>caregivers cannot provide adequate care at home; </li></ul><ul><li>difficulties in administrating ORT: intractable vomiting, ORS refusal, or inadequate ORS intake; </li></ul><ul><li>worsening diarrhea or dehydration despite adequate volumes; </li></ul><ul><li>severe dehydration (>9% of body weight) exists; </li></ul><ul><li>social or logistical concerns </li></ul><ul><li>young age, unusual irritability or drowsiness, progressive course of symptoms, or uncertainty of diagnosis exist that might indicate a need for close observation. </li></ul>
  12. 12. <ul><li>Thank You… </li></ul>