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Flashcards in 1229 Exam 7 Gastroenteritis Deck (41):
1

What is the patho of Gastroenteritis?

An increas in frequency and water content of stools or vomiting, as a result of inflammation of the mucous membranes of the stomach and intestinal tract. Can be viral or bacterial in orgin. All organisms that are implicated in gastroenteritis cause diarrhea!

2

What does gastroenteritis effect?

stomach and intestines

3

What does enteritis effect?

small intestine

4

What does colitis effect?

colon

5

what does enterocolitis effect?

intestines and colon

6

Acute diarrhea

leading cause of illness <14 days.

7

Chronic Diarrhea

last more than 14 days

8

Intractable Diarrhea of Infancy

intractable=incurable or resistant to treatment
first few months of life. >2weeks

9

Chronic Nonspecific Diarrhea (CNSD)

irritable colon 6-54 months of age.
loose stool with undigested food.
>2 weeks duration

10

Causes of viral acute diarrhea

rotavoris
norwalk-like organism

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Causes of bacterial acute diarrhea

e coli
salmonella
shigell
yersina
vibrio
staph
campylobacter
clostridium
c-diff
c-perf
c-botulinum

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Cases of Parasitic acute diarrhea

giardiasis
threadworm
whipworm

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What does it look like?

frequent loose stools
dehydration
electrolyte disturbances
malnutrition

14

How is it diagnosed?

History and physical
laboratory evaluation
urine and blood testing
stool cultures

15

Complication of gastroenteritis?

Dehydration.

when total output of fluids exceeds the total intake

16

Types of dehydration:

-isotonic
(salt and water lost in equal amounts.)
-hypotonic
(loose more electrolytes)
-hypertonic
(loose more water)

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Isotonic Dehydration:

salt and water lost in equal amounts
primary form in children
loss from ECF (extracellular fluid)
reduce plasma volume
effects skin muscles and kidneys
can lead to shock
sodium levels will remain within norm limits

18

Hypotonic Dehydration:

loose more electrolytes than water
serum ishypotonic
ICF more concentrated than ECF
water moved to higher concentration (ICF)
this further dehydrates ECF
shock is a frequent finding
physical symptoms more severe with smaller fluid loses
serum sodium is less than 130*****

19

Hypertonic Dehydration:

loose more water than electrolytes
most dangerous
requires more specific fluid replacement
happens in high protein NG feedings
happens with high solute fluids
fluid shift from less concentration ICF to ECF
serum sodium is greater than 150***
shock is less apparent
neuro disturbances
cerebral changes are serious and may result in permanent damage

20

S&S of dehydration

weight loss
thirst
absence of tears, sunken look to eyes
fontanels sunken
tachycardia
BP decreased
increased H&H
decrease in skin turgor
irritable to lethargy
urine specific gravity >1.020--anuria

21

Treatment goals for dehydration:

assessment (fluid/electrolyte imbalance)
rehydration
maintenance fluid therapy
reintroduction of an adequate diet

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Fluid/Electrolyte Replacement:

ORT: oral rehydration therapy
ORS: Oral rehydration solutions
Maintenace fluid therapy
Early reintroduction of nutrients
intravenous fluid replacement--- only when oral is not possible.

23

What is Giardiasis?

Giardia lamblia
most common intestinal parasitic pathogen in US
cysts can survive for months in environment
mode of transmission: person to person, water, food, and animals

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What are common symptoms of Giardiasis?

abdominal cramps
diarrhea
anorexia
FTT

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What is giardiasis caused by?

the protozoan Giardia lamblia

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How do you diagnose Giardiasis?

stool specimen
direct aspiration of duodenal fluid
biopsy
EIA enzyme immunoassay of specimens
String test.

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Medications for Giardiasis:

Flagyl (metronidazole) -tast bitter, n/v
Tindamax (tinidazole) -taste bitter, n/v 80-100% cure rate with single dose
Albendazole--fewer side effects
Alinia (nitazoxanide) --no bitter taste, give with food to prevent N&V

28

What am I gonna teach my pt?

education to prevent
sanitation practices
medication education

29

Helminthic Infestations

Round worms(nematodes)
1. Ascaris Lumbricoides (Most common roundworm)
2. Necaator Americanus
(Hookworm)
3. Trichuris truchiura
(Whipworm)
4. Strongyloides Stercoralis
(threadworm)
5. Enterobius vermicularis
(pinworm)

30

Ascaris lumbricoides
(Most common roundworm)

Ascar if she is gonna be round.

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Necaror americanus
(Hookworm)

Americans are hooked

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Trichuris trichiura
(Whipworm)

I can pop a mean trich whip

33

Strongyloids stercoralis
(threadworm)

This one has strong threads

34

Enterobius vermicularis (pinworm)

don't go "en the pin"

35

Enterobiasis (Pinworms)

What is it???

- Enterobius vermicularis (nematode, human pinworm)

-Most common helminth infection (40k Infected)

-Eggs are ingested/inhaled then hatch in upper intestine.

-Adult females migrate to anus and lay
eggs

-Eggs can live in the environment for 2-3 weeks.

36

Enterobiasis (Pinworms)

What does it look like???

- Most common symptom
`intense itching at the anal area
`Bed-wetting
`Irritable, restlessnes, poor sleep
`perianal dermatitis, vaginal/urethral infection

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Enterobiasis (Pinworms)

How is it diagnosed???

Tape test (see diagram)

38

Enterobiasis (Pinworms)

How is it treated???

Medications:
-Mebendazole (vermox) choice (not under 2 years)
-Pyrantel pamoate (antiminth)
-Piperazine phospate (pripsen)
-Pyrvinium pamoate (Povan) (Stool and emesis brigt red)

-- Entire family s treated
-1 dose initially
`2nd dose in 2 weeks (to prevent re-infection)

-- If re-infected
` Start over with same tx

39

What am I gunna teach???

-Proper testing for pinworms
(Tape test)

-Medication education
(I dose now and 2nd dose in 2 weeks)

-Prevention of re-infection
`Wash all clothes and bed linens in hot water
`Vacuum carpets
`Hand washing
`Short nails
`One piece PJ's
`Show not tub

40

Additional Helminthic Infestations

Flukes (trematode)

Passed to humans via snail-contaminated water

41

Additional Helminthic Infestations

Tapeworms (cestodes) 5 TYPES*

1. Cattle
2. Fish
3. Dogs
4. Pigs
5. Rodents

-Occurs upon ingestion of under cooked beef, raw fish, contaminated food or water, accidentally swallowing of flea, lice, roach,