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    HISTORY TAKING: Acute Gastroenteritis

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    1. This document outlines the steps for taking a history and performing a physical examination for a case of acute gastroenteritis in a child. 2. It includes questions about symptoms of vomiting, diarrhea, fever and other associated complaints to determine the severity and duration of illness. 3. The physical examination focuses on assessing dehydration status, abdominal examination and systemic examination to identify potential complications and guide management.

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    HISTORY TAKING: Acute Gastroenteritis

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    Sham
    801 views4 pages
    1. This document outlines the steps for taking a history and performing a physical examination for a case of acute gastroenteritis in a child. 2. It includes questions about symptoms of vomiting, diarrhea, fever and other associated complaints to determine the severity and duration of illness. 3. The physical examination focuses on assessing dehydration status, abdominal examination and systemic examination to identify potential complications and guide management.

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    HISTORY-TAKING-AGE

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    1. This document outlines the steps for taking a history and performing a physical examination for a case of acute gastroenteritis in a child. 2. It includes questions about symptoms of vomiting, diarrhea, fever and other associated complaints to determine the severity and duration of illness. 3. The physical examination focuses on assessing dehydration status, abdominal examination and systemic examination to identify potential complications and guide management.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    801 views4 pages

    HISTORY TAKING: Acute Gastroenteritis

    Uploaded by

    Sham
    1. This document outlines the steps for taking a history and performing a physical examination for a case of acute gastroenteritis in a child. 2. It includes questions about symptoms of vomiting, diarrhea, fever and other associated complaints to determine the severity and duration of illness. 3. The physical examination focuses on assessing dehydration status, abdominal examination and systemic examination to identify potential complications and guide management.

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    © All Rights Reserved
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    of 4

    HISTORY TAKING: Acute Gastroenteritis

    1. How many episodes of VOMITING and DIARRHOEA, how many days prior to
    admission?
    2. When is the child last well?
    3. How many days of hospitalization already? (Day of illness on hospitalization)

    HOPI
    1. Previously healthy when?
    2. What is the initial symptom?
    3. Any fever? High grade/low?
    Continuous/intermittent?
    Chills/rigors?
    Relieving factors?
    4. Any respiratory symptoms? (Runny nose, cough…)
    5. Vomiting How many episodes?
    Contain?
    Blood stained/bile?
    Posstussive/projectile?
    Amount?
    Relieving/triggering factors?
    6. Diarrhoea Frequency/consistency of passing stool?
    Colour of stool/any blood stained (HUS)?
    Abdominal pain?
    Abdominal distension?
    7. Travelling history?
    8. Urine output (Amount, frequency, colour) “Dark coloured urine-Haemolytic
    uraemic syndrome”
    9. Oral intake (reduced? Unable to drink?)
    10.Any headache, relieve by sleep? (TRO migrain)
    11.Last food intake What food?
    When?
    Expired/not?
    Any friends/family has the same symptoms?
    Food preparation/water supply?
    12.Did symptoms affect sleeps, feeding, daily activities?
    13.Did child irritable, lethargy?
    14.Any wrongly taken medication?
    15.Any dehydration (sweating? Dry mouth? Muscle cramps? Palpitation? Fast
    breathing?)

    ROS
    CNS: any fit, altered consciousness
    HEMATO: any pallor, bleeding
    CVS: Sweating during feed, palpitation
    Provisional diagnosis
    Acute gastroenteritis + DEHYDRATION STATUS!

    PHYSICAL EXAMINATION
    1. General 3. Local: Abdomen
    2. Systemic 4. Dehydration assessment

    Dehydration status
    *child general condition
    1. Anterior fontanelle (infant) – sunken
    2. Mouth (dry mouth, tongue)
    3. Eye (sunken, any tears)
    4. Pulse rate/BP (tachycardia, degree of dehydration “shock”)
    5. Cold peripheries (weak pulse, CRT >2s “shock”)
    6. Skin turgor

    Local Examination: Abdomen


    *Look for complication of AGE
    1. Any tenderness (peritonitis, sepsis of GIT)
    2. Mass and central tenderness (intussusception)
    3. Percussion if hyper resonant (Intestinal Obstruction)
    4. Bowel sounds (increase in IO, absent in paralytic ileus/peritonitis)

    Systemic examination

    Respiratory: Tachypnoea with crepitation/ rhonchi (metabolic acidosis)

    Cardiovascular: Signs of shock ‘tachycardia, cold peripheries, weak pulse, CRT >2s,
    depressed
    mental state with/without hypotension’

    Central Nervous: Any seizure (fever, electrolyte imbalance), hyper/hyponatraemia,


    hypokalaemia,
    conscious level, signs of cerebral oedema

    Investigations
    1. FBC (wbc, hb, platelets levels)
    2. BUSE (electrolyte imbalance due to dehydration, hyper/hyponatraemia,
    hypokalaemia)
    3. Blood C&S
    4. UFEME + C&S (any RBC suggest: HUS, UTI ‘E. coli, Shigella, Camphylobacter)
    5. Stool FEME + C&S (any RBC suggest HUS)
    6. ECG (severe dehydration look for hypo/hyperkalaemia ‘T wave changes’)
    7. ABG (evidence of metabolic acidosis)
    Management
    Mild (<5%) PLAN A
    Dehydration Moderate (5-10%) PLAN B
    Severe (>10%) PLAN C

    PLAN A
    1. Give extra fluid
    Encourage Breast feeding
    ORS/ education on preparation (after each loose stool)

    2. Continue feeding
    Avoid sugar, continue BF on demand

    3. When to return
    Unable to drink/BF/drink poorly, become sicker, develop fever, blood in stool
    PLAN B
    1. ORS over 4hr period
    ORS(ml) = wt(kg) × 100ml (according to age)

    2.After 4 hours
    Reassess the child condition
    Select appropriate plan to continue
    If discharge before completing treatment, need to give home treatment and educate
    the parents
    Continue BF

    PLAN C/SHOCK
    1. IV/IO fluid started immediately
    If patient can drink, give ORS by mouth while setting drip
    Bolus 20ml/kg NaCl o.9%
    Repeated until patient out of shock!

    2. Fluid needed for the next 24hr


    Fluid rehydration/deficit
    Fluid maintenance

    3. Reassess hydration status 1 hourly


    4. Continue normal feed
    5. Once the child able to feed and not vomit PLAN A/B

    COMPLICATION
    - Hypovolaemia - Dehydration
    - Fit - Bacteraemia
    - Malnutrition - Matabolic disturbance

    ORS Contain: NaCl, KCl, trisodium citrate, glucose anhydrous

    Differential diagnosis
    1. Food poisoning
    2. Allergy
    3. Malabsoption
    4. Celiac disease
    5. IBD
    6. Intussusception
    7. HUS
    8. UTI

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