Viral gastroenteritis Flashcards
Define gastroenteritis
Transient disorder due to enteric infection with viruses, bacteria or parasites
Define food poisoning
illness caused by the consumption of food or water contaminated with bacteria and/or their toxins, or viruses, parasites, or chemicals
Define dysentery
acute infectious gastroenteritis characterised by diarrhoea with blood and mucus
Define outbreak
Two or more cases associated in time and place
Define traveller’s diarrhoea
developing diarrhoea at a destination abroad with at least one additional symptom (abdominal cramps, tenesmus, nausea, vomiting, fever, faecal urgency), involves travel from LMICs
What are the causes of gastroenteritis
Most commonly self-limiting viruses
Faeco-oral, foodbornes, environmental transmission
Viruses: rotavirus, norovirus, adenovirus
Bacteria: Campylobacter, E. Coli, salmonella, Shigella, Yersinia
Parasites: Cyrptosporidiosis, entamoeba, giardia
What are the symptoms and signs of gastroenteritis
Diarrhoea (sudden onset, ± blood, mucous, faecal urgency)
Nausea and vomiting
Fever
Abdo pain and cramps
General malaise
Headache, myalgia, bloating, flatulence, weight loss, malabsorption
Define acute diarrhoea
3 or more episodes of liquid or semi-liquid stool in a 24h period, <14 days
What investigations should be done for gastroenteritis
Bedside: stool culture, ova and parasite testing
Bloods: FBC, U&Es, glucose, blood cultures
What necessitates hospital admission for gastroenteritis
Systemically unwell and/or there are clinical features suggesting sever dehydration and/or progression to shock
There is intractable or bilious vomiting
Acute-onset painful, bloody diarrhoea
Confirmed STEC infection O157
Suspected serious complication e.g. HUS, sepsis
What is the management for gastroenteritis
Assess dehydration status
Not dehydrated → continue with usual feeds, regular fluid intake, avoid fruit juice/carbonated drinks, consider ORS if at risk
Dehydrated → oral rehydration solution (ORS) + advice (above), consider IV fluids if persistently vomiting
- ≤ 5 years: 50mL/kg over 4 hours
- > 5 years: 200mL after each loose stool (in addition to normal fluid intake)
Shock → admit + Immediate IV resuscitation (IV 0.9% Saline 20mL/kg over < 10 minutes)
Consider notifying the local health protection team
Prevention of transmission
What advice should be given regarding preventing transmission of gastroenteritis
Always flush if possible
Handle potties with gloves, wash with hot water and detergent
Wash hands after going to the toilet and changing nappies
Clean toilet seats, flush handles, wash-hand basin taps, surfaces, and toilet door handles once a day
Do not share towels and bathwater
Wash soiled clothing and bedding at a high temperature
School exclusion until at least 48 hours after the last episode
No swimming (for 2 weeks if cryptosporidiosis or giardiasis suspected)
What are the complications of gastroenteritis
Dehydration, electrolyte disturbance, AKI
Acquired or secondary lactose intolerance (post gastroenteritis syndrome)
Haemolytic uraemia syndrome
Thrombotic thrombocytopenic purpura
Reactive arthritis (Reiter’’s)
Sepsis
Toxic megacolon
Pancreatitis, sclerosing cholangitis, liver cirrhosis
Faltering growth
Irritable bowel syndrome
Inflammatory bowel syndrome
Guillain Barre (campylobacter)
What is the prognosis for gastroenteritis
Diarrhoea usually lasts 5–7 days, and in most children stops within 2 weeks.
Vomiting usually lasts 1–2 days, and in most children stops within 3 days.
Describe clostridium perfringens infection
Causes food poisoning
Usually caused by inadequate storage and insufficient reheating of contaminated meat dishes or cooked meats or meat products e.g. institutional catering settings