Acute Gastroenteritis

Question 1

What is gastroenteritis?

Answer 1

inflammation of the gastrointestinal tract that usually manifests with acute diarrhea, vomiting, and/or abdominal pain

Question 2

What is infectious gastroenteritis?

Answer 2

gastroenteritis caused by pathogens moct commonly viruses but can also be causes bacteria, parasites and fungi

Question 3

What is mild to moderate gastroenteritis?

Answer 3

• Abdominal pain with normal abdominal examination
• Mild diarrhea, nausea, and/or vomiting

Question 4

What is severe gastroenteritis?

Answer 4

Gastrointestinal features
- Bloody stools
- Severe diarrhea, nausea, and/or vomiting
- Severe abdominal cramping and/or tenderness
Systemic features
- Fever (≥ 38.3°C) or sepsis
- Clinical signs of significant dehydration
- End-organ damage
- Duration > 1 week

Question 5

Etiology?

Answer 5

1. viral - most cases
2. bacterial (20% of cases)
3. parasites e.g. Giardia lamblia - should be considered in children with persistent diarrhea

Question 6

Clinical features?

Answer 6

1. nausea and vomiting
2. fever
3. abdominal pain
4. diarrhea

Question 7

What clinical features raise concern for severe illness?

Answer 7

1. fever >40 degrees or tachypnea
2. signs of poor peripheral perfusion
3. bloody or bilious emesis
4. petechiae
5. altered mental status or excessive crying/fussiness

Question 8

Important points in history?

Answer 8

1. Diarrhoea - frequency of stools, number of days, blood or mucous in stools.
2. Vomiting - frequency, blood, contents, associated with feeding
3. Local reports of cholera outbreak or other contacts unwell
4. Recent antibiotic or other drug treatment
5. Attacks of crying with pallor in an infant - intussusception
6. Feeding history
7. Fever
8. Local mankhwala (medicine)
9. Urine Output
10. Vaccination history (query Rotavirus)

Question 9

Important points on examination?

Answer 9

1. Assess for emergency signs ABCD
2. Shock
   - cold hands, capillary refill >3 secs, fast, weak pulse
3. Severe Malnutrition
   - visible severe wasting or oedema of both feet
4. Assess Hydration
5. Abdominal examination looking particularly for surgical problems
   e.g. distension, tenderness, guarding or a mass
6. Is there any evidence of sepsis

Question 10

Relevant investigations?

Answer 10

1. Blood glucose
   - if low BCS, or lethargic
2. Stool culture rarely indicated or available (but important if suspected cholera see below)
3. Creatinine, urea and electrolytes/blood gases
   - if acidotic, poor urine output
4. Blood culture
   - if high fever, long history, suspicion of Typhoid

Question 11

Indications for admission?

Answer 11

1. Gastroenteritis with severe dehydration
2. Vomiting all oral fluids/ ORS or unable to receive oral fluids in A&E (i.e. lethargy)
3. Social concerns
4. Uncertainty about diagnosis
5. Repeated presentation with no improvement in symptoms

Question 12

Gastrointestinal causes of gastroenteritis?

Answer 12

1. gastrointestinal causes of acute abdomen
   e.g. appendicitis, bowel obstruction
2. inflammatory bowel disease
3. congenital disorders with diarrhea
   e.g. Hirschprungs, intestinal malrotation with midgut volvulus, congenital diarrhea
4. intussusception
5. functional diarrhea
6. antibiotic associated diarrhea

Question 13

Extra-intestinal causes of gastroenteritis?

Answer 13

1. pneumonia
2. meningitis in children
3. otitis media
4. UTI in children and adolescents
5. toxic shock syndrome

Question 14

Treatment of gastroenteritis for all patients?

Answer 14

1. Maintain adequate oral intake through breastfeeding or age-appropriate foods
2. Zinc supplementation is recommended for patients with malnutrition or in low-income regions
3. Educate patients and/or caregivers on preventing onward transmission of gastroenteritis

Question 15

Treatment of mild to moderate gastroenteritis?

Answer 15

1. Encourage fluid intake
2. Give oral rehydration solution (ORS) if signs of moderate dehydration are present
3. Advise caregivers to seek medical assistance if signs of significant dehydration develop

Question 16

Treatment of severe gastroenteritis or children with admission criteria for dehydration?

Answer 16

1. Admit to hospital and initiate contact precautions.
2. Identify patients in shock and start IV fluid resuscitation.
3. Initiate treatment of dehydration and electrolyte repletion with either IV fluids or ORS.

Question 17

Complications of gastroenteritis?

Answer 17

1. dehydration
2. malnutrition
3. electrolyte imbalance
4. reactive arthritis e.g. following infection from Salmonella, Shigella
5. secondary lactase deficiency
   - may causes symptoms of lactose intolerance

Question 18

Prevention?

Answer 18

1. food and water hygiene
2. Educate patients and caregivers on preventing onward community transmission of infectious gastroenteritis
3. Regular hand hygiene with soap and water including after changing diapers.
4. Clean bathrooms, high-touch, and contaminated areas with bleach-based cleaners.