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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.

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