A 13-year-old boy presented to the primary health center complaining of recent vomiting, watery stool, abdominal cramps and discomfort. The document discusses evaluating and managing gastroenteritis, including assessing for dehydration, treating any underlying infection, and providing intravenous fluids and electrolyte replacement as needed. The differential diagnosis and potential complications are also reviewed.

2. A 13 year old boy came to the PHC complaining of a
recent episode of vomiting and watery stool,
preceded by abdominal cramps and discomfort.
Q1: what is your Dx?
A: Gastroenteritis.
Q2: What is your approch?
Q3: How will you manage such a case in
the ER?

3. 1. The Severity.
2. The Golden Concept In Managing Any Disease:

4. The Signs and Symptoms of
Dehydration

5. Symptoms Signs
Thirst Dry Skin (skin turgor )
Mild ( 2% ) Loss of Appetite Dark Colored Urine
Dry Mouth
dizziness, faintness or postural hypotension
light-headedness when
they stand up

6. Symptoms Signs
Moderate (5% ) Decreased sweating Increased heart rate
Decreased urination Increased respiration
Extreme fatigue Increased body temperature
Muscle cramps Sunken of the eye
Headaches Prolonged capillary refill ( > 2 sec )
Nausea BP normal or low
Tingling of the limbs

7. Symptoms Signs
Severe ( 10% or more ) Muscle spasms Racing pulse
Vomiting Low blood pressure
Dim vision Increased respiration
Painful urination Dry Skin (skin turgor )
retracts very slowly
Confusion
Sunken of the eye
Difficulty breathing
Prolonged capillary refill ( > 2
Seizures
sec )
Chest and Abdominal pain

8. Management & Treatment
In PHC

9. Complications of Gastroenteritis

10. Pseudomembranous Colitis.
inflammation of the colon by Clostridium difficile, caused by treatment with
antibiotics.
symptoms: diarrhea, cramping abdominal pain, blood in the stool, nausea,
vomiting, and fever.
Treatment :
I. Stop antibiotics.
II. Oral vancomycin.

11. Electrolyte Imbalance
Hypokalemia and hypernatremia
Due conyineous diarria
Treatment: intravenous fluids, and oral potassium
supplements.

12. Hypovolemic Shock
Due to the sever dehydration
Symptom: ???
Treatment: ???

13. GBS
Occur after 2 week of gastritis
Symptoms : proximal muscle weakness, absent of tendon reflex,
hypotonia.
Treatment: 1) I.V. IG.
2) plasma phoreses.

14. Differential diagnosis
• Infection
• Acute Abdomen
• Bowel Obstruction
• Inflammatory Bowel disease
• Food Allergies
• Drugs

15. Infection
• Viruses : the most common
Norovirus(Caliciviridae), Rotavirus ,
Adenoviruses (Respiratory), Parvoviruses, HIB A.
• Bacteria : Staphylococcus aureus, Escherichia
coli, Salmonella, Campylobacter,Shigella,
Clostridium difficile .
• Parasites :Giardia, Antamiba histolotica
Cryptosporidium .

16. Diagnosis of infection
• CBC , Chemistry , electrolytes , Abdominal
Imaging.
• Bacterial : Sign( High fever, Bloody dairrhea, sever
abdominal pain ) + Investigation (Test of blood for
WBC by methylene blue +ve Culture .
• Viral :short prodrome, with mild fever and
vomiting, followed by 1-4 days of nonbloody,
watery diarrhea) Rapid antigen testing of
the stool.
• Parasites :Direct Examination of stool for eggs &
AFB satin for Cryptosporidia .

17. Treatment
• IF Viral Self limiting
• IF Bacterial Proper Antibiotic
• With invasive pathogen Ciprofloxacin
• IF Protzol Metronidazol
• If acute abdomen Investigate for Dx
then decide suitable management.
• If it was due to chemical toxins or drugs
stop the expouser.