Gastroenteritis

THI-QAR MEDICAL COLLAGE

INTERNAL MEDICINE
SUPERVISED BY
DR HAIDER AL-YASIRY
SIXTH STAGE/GROUP D3
Done by
• SAMA ABBAS BEDEIWY

Gastroenteritis

What is gastroenteritis?

Gastroenteritis is an inflammation of the gastrointestinal tract
Gastroenteritis is also sometimes referred to as "stomach flu," even though it may not be related to influenza

How common is gastroenteritis?

Because gastroenteritis is so similar to diarrhea, and because so many cases do not require hospitalization, it is difficult to determine how many cases of gastroenteritis occur per year. Worldwide, it is estimated that 3 to 5 billion cases of acute diarrhea (which can be caused by many other diseases besides gastroenteritis) occur per year


Pathophysiology
Gastroenteritis is defined
as vomiting or diarrhea
due to inflammation of
the small or large bowel,
often due to infection.
The changes in the small bowel are typically noninflammatory, while the ones in the large bowel are inflammatory.The different numbers of pathogens required to cause an infection

Causes

• Viruses
• Bacteria
• Parasites
• Fungus
In children, rotavirus is the most common cause of severe disease. In adults, norovirus and Campylobacter are common causes

Who is at risk for gastroenteritis?

Anyone can get the disease. People who are at a higher risk include:
* Children in daycare
* Students living in dormitories
* Military personnel
* Travelers
People with immune systems that are weakened by disease or medications or not fully developed (i.e., infants) are usually affected most severely


Signs and symptoms
Gastroenteritis usually involves both diarrhea and vomiting.Sometimes, only one or the other is present.
This may be accompanied by abdominal cramps.
Signs and symptoms usually begin 12–72 hours after contracting the infectious agent.If due to a virus, the condition usually resolves within one week.Some viral infections also involve fever, fatigue, headache and muscle pain.If the stool is bloody, the cause is less likely to be viral and more likely to be bacterial.Some bacterial infections cause severe abdominal pain and may persist for several weeks.

Children infected with rotavirus

usually make a full recovery within
three to eight days.
However, in poor countries
treatment for severe infections
is often out of reach
and persistent diarrhea is
common.

Transmission

By eating improperly prepared food, drinking contaminated water or close contact with a person who is infected can spread the disease.


COMPLICATIONS
• Dehydration: is a common complication of diarrhea.Severe dehydration in children may be recognized if the skin color and position returns slowly when pressed.This is called "prolonged capillary refill" and "poor skin turgor".Abnormal breathing is another sign of severe dehydration
• Reactive arthritis occurs in 1% of people following infections with Campylobacter species.

• Guillain–Barré syndrome occurs in 0.1%.

• Hemolytic uremic syndrome (HUS) may occur due to infection with Shiga toxin-producing Escherichia coli or Shigella species.
• Some viral infections may produce benign infantile seizures.

Diagnosis

Gastroenteritis is typically diagnosed clinically, based on a person's signs .

Diagnostic method

• Based on symptoms, occasionally stool culture
• Electrolytes and kidney function should also be checked when there is a concern about severe dehydration

Differential diagnosis

• Inflammatory bowel disease
• Malabsorption syndrome
• Lactose intolerance
• Diabetic ketoacidosis (DKA)
• Coeliac diseas


Management
Gastroenteritis is usually an acute and self-limiting disease that does not require medication.
Treatment
• Rehydration: The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by drinking rehydration solution, although intravenous delivery may be required if there is a decreased level of consciousness or if dehydration is severe.

• Antiemetics

For children at risk of dehydration from vomiting, taking a single dose of the anti vomiting medication metoclopramide or ondansetron, may be helpful
• Antibiotics
Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe or if a susceptible bacterial cause is isolated or suspected

• If antibiotics are to be employed, a macrolide (such as azithromycin) is preferred

• Pseudomembranous colitis, usually caused by antibiotic use, is managed by discontinuing the causative agent and treating it with either metronidazole or vancomycin.
• Bacteria and protozoans that are amenable to treatment include Shigella, Salmonella typhi and Giardia species.In those with Giardia species or Entamoeba histolytica, tinidazole treatment is recommended and superior to metronidazole.

• Antimotility agents

Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea.Loperamide is not recommended in children, however, as it may cross the immature blood–brain barrier and cause toxicity.

• Zinc supplementation is recommended in children.

Prevention
• Hand washing with soap
• Drinking clean water
• Proper disposal of human waste
• Breastfeeding babies instead of using formula.
• The rotavirus vaccine is recommended as a prevention for children.


Thank you