Acute Gastroenteritis

Acute gastroenteritis
SANDHYA BASNET
Introduction
 Diarrhea reflects increased water content of the stool,

whether due to impaired water absorption and/or active
water secretion by the bowel.
 In severe infectious diarrhea, the number of stools may
reach 20 or more per day, with defecation occurring
every 20 or 30 minutes.
causes
 Viral (50-70%) causes of gastroenteritis

Norovirus,Rotavirus
 Bacterial (15-20%) causes of gastroenteritis
Salmonella,c.Difficle,e.Coli,v.Cholera
 Parasitic (10-15%) causes of gastroenteritis
Giardia,amebiasis
 Food-borne toxigenic diarrhea e.g, Shellfish poisoning
 Drug-associated diarrhea e.g, Antibiotics,Laxatives.
Pathophysiology
 Infectious agents cause diarrhea by several mechanisms, including

adherence, mucosal invasion, enterotoxin production, and/or
cytotoxin production.
 These mechanisms result in increased fluid secretion and/or
decreased absorption.
 Motility of intestine increases.
 This produces an increased luminal fluid content for washing the
infectious agent.
 These fluids cannot be adequately reabsorbed, leading to
dehydration and the loss of electrolytes and nutrients.
Cont..
Diarrheal illnesses may be classified as follows:
 Osmotic, due to an increase in the osmotic load presented to the
intestinal lumen, either through excessive intake or diminished
absorption. E.g, Certain laxatives such as lactulose and citrate of
magnesia or maldigestion of certain food substances such as milk
 Inflammatory (or mucosal), when the mucosal lining of the
intestine is inflamed by microorganisms.
 Secretory, when increased secretory activity occurs by bacterial
toxins, reduced absorptive surface area caused by disease or
resection
 Motile, caused by intestinal motility disorders such as
Gastroesophageal reflux disease .
Cont..
 The small intestine is the prime absorptive surface of the
gastrointestinal tract.
 The colon then absorbs additional fluid, transforming a
relatively liquid fecal stream in the cecum to well-formed
solid stool in the rectosigmoid.
Contd..
 Disorders of the small intestine result in increased amounts of diarrheal

fluid with a concomitantly greater loss of electrolytes and nutrients.
 Microorganisms may produce toxins that facilitate infection. Enterotoxins,
generated by some bacteria (ie, enterotoxigenic Escherichia coli, Vibrio
cholera) act directly on secretory mechanisms and produce a typical,
copious watery (rice water) diarrhea.
Clinical features
• Pulse rate > 90

• Postural hypotension
• Supine hypotension and absence of palpable pulse
• Dry tongue , Sunken eyeballs, Skin pinch
• Signs of severity:
 • Disorientation, lethargic
 • Anuria
 • Hypotention, cold periphery
Evidence base for over-the-counter
medication
 Oral rehydration solution
 Bismuth subsalicylate - Bismuth subsalicylate has been shown to be
effective in treating traveller’s diarrhea.
 Loperamide - It slows intestinal tract time increasing the water resorbing
capacity of the gut.
 Rotavirus vaccine - rotavirus vaccine was added to the routine childhood
vaccination schedule. The oral vaccine is given as two doses, the first at 2
months and the second at 3 months , alongside other routine childhood
vaccinations
Management
Rehydration
 Administration of 1-2 L dextrose 5% in 0.5 isotonic sodium chloride solution
with 50 mEq NaHCO3 and 10-20 mEq KCl over 30-45 minutes may be
necessary in patients who are severely dehydrated.
 To give fluids more rapidly, KCl may be given orally or in the second or third
liter bag or as a supplemental IV of 20 mEq KCl in 100 mL of isotonic sodium
chloride solution over 1 hour. Ensure normal renal function prior to KCl
administration.
Contd..
 Rehydrate patients until mental status and signs of perfusion and pulse are
normal (caution in elderly patients with congestive heart failure [CHF]), such
as a urine output of 1-2 mL/kg/h.
Cont..
 For pediatric patients, administer 20 mL/kg of isotonic sodium chloride solution
initially for resuscitation. Repeat as necessary and add KCl as indicated.
 Indications for IV rehydration include severe intractable vomiting, altered
consciousness, severe dehydration, ileus, excessive cholera like stools, and time
or environment not conducive to oral rehydration therapy (ORT).
Solutions for oral rehydration
Contd..
 Other oral rehydration products include Naturalyte, Cera Lyte,

Rehydralyte, and Pedialyte.
 Oral rehydration may not decrease the duration or volume of
diarrhea.
 Small amounts of oral fluids may be given repeatedly while the
patient is still vomiting.
Refeeding
 Early refeeding with complex carbohydrates stimulates mucosal repair.

 Consider rice, wheat, bread, potatoes, and lean meats, especially chicken.
Empiric therapy
 The duration of traveler's diarrhea (E coli, Shigella) can be shortened by
half or more with trimethoprim-sulfamethoxazole (TMP/SMZ) or
ciprofloxacin administered for 3 days.
 Generally, fluoroquinolones are the drugs of choice for acute infectious
gastroenteritis when used empirically. they are contraindicated in pregnant
women and in children.
Contd..
 Erythromycin or azithromycin is effective

in Campylobacter infections, although erythromycin is not well tolerated
in the patient who is vomiting.
 Metronidazole (oral or parenteral) is effective in mild-to-moderate
cases of C difficile diarrhea (in addition to discontinuance of the
causative agent).
 Patients who are severely ill may require orally administered
vancomycin, which may require delivery via nasogastric tube.
Contd..
 Antiemetics domperidone or ondansetron.

 Antidiarrheals -The most common agents include bismuth subsalicylate
(Pepto-Bismol). For patients older than 14 years, give 2 tablets or 20 mL
PO q30min as needed to a maximum of 8 doses.
 Loperamide (Imodium) is useful as an adjunct to rehydration for symptomatic
relief. The American Academy of Pediatrics (AAP) does not recommend this
for children.

Acute Gastroenteritis

Uploaded by

Copyright:

Available Formats

Acute Gastroenteritis

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Acute Gastroenteritis

Uploaded by

Copyright:

Available Formats

Acute gastroenteritis

 Diarrhea reflects increased water content of the stool,

 Viral (50-70%) causes of gastroenteritis

 Infectious agents cause diarrhea by several mechanisms, including

 Disorders of the small intestine result in increased amounts of diarrheal

• Pulse rate > 90

 Other oral rehydration products include Naturalyte, Cera Lyte,

 Early refeeding with complex carbohydrates stimulates mucosal repair.

 Erythromycin or azithromycin is effective

 Antiemetics domperidone or ondansetron.

You might also like