Gastroenteritis

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Written by an American family doctor, this slide show focuses on gastroenteritis. Mostly geared to expats in Beijing, it's also relevant to all.

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Gastroenteritis

  1. 1. Gastroenteritis Richard Saint Cyr MD DABFP [email_address] www.myhealthbeijing.com August 2, 2009
  2. 2. Case: Sushi & Salad Leftovers
  3. 3. Case: Sushi & Salad Leftovers <ul><li>A 45 year old woman eats leftovers of sushi and salad (1 day in fridge). Two days later, she has diarrhea, stomach cramps, gas, and vomiting. </li></ul>
  4. 4. Question: What Should She Do? <ul><li>Sue the restaurant </li></ul><ul><li>Rehydrate at home, take OTC Rx </li></ul><ul><ul><ul><ul><li>OTC = “Over the counter”, no MD Rx needed </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Rx = MD prescription </li></ul></ul></ul></ul><ul><li>Go to clinic doctor </li></ul>
  5. 5. Dx: Gastroenteritis <ul><li>Latin: “inflammation of the stomach” </li></ul><ul><li>AKA Traveler’s diarrhea 胃腸炎 wèichángyán </li></ul><ul><ul><li>AKA “Turista” </li></ul></ul><ul><li>Infection: </li></ul><ul><ul><li>Developed countries: virus>bacteria>parasite </li></ul></ul><ul><ul><li>Developing countries: bacteria>virus>parasite </li></ul></ul><ul><ul><ul><ul><ul><li>Virus = 病毒 bìngdú </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Bacteria = 细菌 xì jūn </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Parasite = 寄生虫 [jìshēngchóng] </li></ul></ul></ul></ul></ul>
  6. 6. The Main Players… Thanks, www.giantmicrobes.com <ul><li>Parasite </li></ul><ul><li>Largest group </li></ul><ul><li>Worms </li></ul><ul><li>Giardia – dirty water </li></ul><ul><li>Bacteria </li></ul><ul><li>Larger than virus </li></ul><ul><li>Living </li></ul><ul><li>E coli; salmonella , shigella… </li></ul><ul><li>Virus </li></ul><ul><li>Smallest </li></ul><ul><li>Not living </li></ul><ul><li>Needs to reproduce in a host cell </li></ul><ul><li>Hepatitis A </li></ul><ul><li>Norovirus - cruises </li></ul>
  7. 7. Why So Common? <ul><li>Eating food contaminated with feces </li></ul><ul><ul><li>Human; cow; pigs… </li></ul></ul><ul><li>Improper food handling </li></ul><ul><li>Poor hygiene (hand washing after toilet…) </li></ul><ul><ul><li>Restaurants </li></ul></ul><ul><ul><li>Street food </li></ul></ul><ul><li>Improper cooking </li></ul><ul><li>Improper washing </li></ul>
  8. 8. Symptoms: Bacteria 细菌 <ul><li>Common: </li></ul><ul><ul><li>Diarrhea 拉肚子 (>3 loose stools per day); nausea 恶心 ; vomiting 呕吐 ; cramps; no appetite; blood in stool </li></ul></ul><ul><li>Uncommon: </li></ul><ul><ul><li>Fever 发烧 </li></ul></ul><ul><li>Serious: </li></ul><ul><ul><li>Dehydration 脱水的 tuōshuǐde </li></ul></ul><ul><li>Usual Course: </li></ul><ul><ul><li>Lasts 1-4 days </li></ul></ul><ul><ul><li>Starts within 2 weeks of ingestion </li></ul></ul>
  9. 9. Symptoms: Parasite 寄生虫 <ul><li>Common: </li></ul><ul><ul><li>Diarrhea with cramps after eating; mild nausea; bad bloating & gas 串气 ; no appetite </li></ul></ul><ul><li>Uncommon: </li></ul><ul><ul><li>Fever </li></ul></ul><ul><li>Serious: </li></ul><ul><ul><li>Dehydration </li></ul></ul><ul><li>Usual Course: </li></ul><ul><ul><li>Slower & milder onset </li></ul></ul><ul><ul><li>Can last weeks-months </li></ul></ul>
  10. 10. Prevention <ul><li>Home foods - peel; wash; cook </li></ul><ul><li>Restaurants – Look for rating A/B </li></ul><ul><li>Street food – buyer beware </li></ul><ul><li>Wash hands </li></ul><ul><li>Traveling: daily preventive Rx </li></ul><ul><ul><li>Antibiotics – not advised </li></ul></ul><ul><ul><li>Bismuth (Pepto-Bismol 次水杨酸铋 ) </li></ul></ul><ul><ul><li>Probiotics “good bacteria” 益生細菌 yì shēng xì jūn </li></ul></ul><ul><ul><ul><ul><li>OTC: Medilac-S </li></ul></ul></ul></ul>
  11. 11. Fruit & Vegetable Washes
  12. 12. How To Prevent Giving To Others <ul><li>Spread by hand-to-hand contact, so… </li></ul><ul><ul><li>Hand washing: </li></ul></ul><ul><ul><ul><li>after toilet </li></ul></ul></ul><ul><ul><ul><li>before & after cutting up food </li></ul></ul></ul><ul><li>Not contagious in air </li></ul>
  13. 13. Hand Washing: Soap
  14. 14. Hand Washing: Alcohol-gel
  15. 15. Self Treatment <ul><li>Diarrhea: </li></ul><ul><ul><li>Lomotil 易蒙停 is best choice </li></ul></ul><ul><ul><li>Smecta 思密达 - charcoal </li></ul></ul><ul><ul><li>Medilac 妈咪爱 – good bacteria </li></ul></ul><ul><li>Nausea: ginger 姜 jiāng ; salt crackers </li></ul><ul><li>Fluids: </li></ul><ul><ul><li>Oral Rehydration Salts 口服补液盐 </li></ul></ul><ul><ul><li>Not just water! </li></ul></ul><ul><ul><li>Pocari, Gatorade drinks </li></ul></ul><ul><ul><li>Chicken soup 鸡汤 with ginger </li></ul></ul><ul><li>Children: ORS; no lomotil <2; see doctor </li></ul>
  16. 16. What Clinics Can Do <ul><li>Exam: Dehydrated? </li></ul><ul><li>Lab test: </li></ul><ul><ul><li>Stool culture, parasites; CBC </li></ul></ul><ul><li>Rx: </li></ul><ul><ul><li>Antibiotic; antiparasite; antinausea </li></ul></ul><ul><li>Intravenous (IV) hydration 靜脉 生理盐水 jìngmài shēnɡlǐyánshǔi </li></ul><ul><li>Hospital/ER: </li></ul><ul><ul><li>Severe dehydration (rare) </li></ul></ul>
  17. 17. Lab test: CBC <ul><li>= “Complete Blood Count” 全部血细胞计数 </li></ul><ul><li>WBC = “White Blood Count” 白细胞计数 </li></ul><ul><ul><li>High = infection </li></ul></ul><ul><li>Lymphocytes 淋巴细胞 = fight virus </li></ul><ul><li>Neutrophils 嗜中性 = fight bacteria </li></ul><ul><li>Other: </li></ul><ul><ul><li>HCT = “hematocrit” 血細胞比容 </li></ul></ul><ul><ul><ul><li>Low = anemia </li></ul></ul></ul><ul><ul><li>PLT = “platelets” 血小板 </li></ul></ul><ul><ul><ul><li>Low = clotting problems </li></ul></ul></ul>
  18. 18. In Your Travel Kit <ul><li>Medicines </li></ul><ul><ul><li>Antibiotics </li></ul></ul><ul><ul><ul><li>Ciprofloxacin 环丙沙星 </li></ul></ul></ul><ul><ul><ul><li>Azithromycin 阿奇霉素 </li></ul></ul></ul><ul><ul><li>OTC: lomotil </li></ul></ul><ul><ul><ul><li>Smecta; medilac; bismuth </li></ul></ul></ul><ul><li>Water purifier tablets (iodine) </li></ul><ul><li>Rx for traveler’s diarrhea: </li></ul><ul><ul><li>Two lomotil + 1 gram antibiotic </li></ul></ul>
  19. 19. Before You Travel… <ul><li>Check CDC website country info </li></ul><ul><ul><li>www.cdc.gov/travel </li></ul></ul><ul><li>Get travel exam at clinic </li></ul>
  20. 20. <ul><li>Sue the restaurant </li></ul><ul><li>Rehydrate at home, take OTC Rx </li></ul><ul><li>Go to clinic doctor </li></ul>What Should She Do?

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