Gastroenteritis Flashcards Preview

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Flashcards in Gastroenteritis Deck (13):

Viral causes of gastro

• Rotavirus: seasonal peak in Autumn and Winter 
• Adenovirus: 7-17% of cases require admission 
• Norovirus 
• CMV enteritis: consider in immunocompromised patients 


Bacterial causes of gastro (5-10%)

• Salmonella spp.  
• Campylobacter jejuni 
• Yersinia enterocolitica 
• Escherichia coli 
• Shigella  
• C. difficile: follows antibiotic therapy  
• Entamoeba histolytica: consider in developing countries  


Parasitic causes of gastro

• Cryptosporidium: consider in immunocompromised patients 
• Giardia: commonly a cause of persistent diarrhoea with flatulence and bloating 


DDx of gastro

• Appendicitis 
• UTI 
• Sepsis 
• Surgical abdomen: intussusception, Hirschprung's, malrotation, pyloric stenosis 
• HUS 
• DKA 
• Malabsorptive disorders: Coeliac disease, CMPI 


What does doughy skin suggest?



What are some initial Ix you might do in severely dehydrated/unwell, or high loss gastros?

Glucose, UEC, ABG/VBG


What are other options for feeding if a patient can't tolerate normal oral intake?

• Slower, smaller feeds
• If not tolerating NGT:
○ Slow rate
○ Give ondansetron
○ Then IV


Why is NGT preferred to IV?

Safer: a) electrolytes b) skin (not necessarily less invasive)


How can feeding affect breathing?

Inc WOB:
- Stomach pushes on diaphragm
- Esp in smaller children, requires a lot of energy to feed


What is the most preferred oral rehydration solution? How do ORSs work?

- Hydralyte
- ORS works via glucose-facilitated sodium transport 


What should you consider if there is persistent diarrhoea after re-introduction of feeds?

lactose intolerance


What pharmacotherapy is recommended for gastro?

• No treatment with antidiarrhoeals is recommended 
• Most bacterial infections do not require Abx even if there is presence of blood or mucous 
• Ondansetron once

• Indications for Abx treatment 
○ Salmonella/camp/shigella/c.difficile/giardia 
○Sepsis, extra-intestinal spread of bacterial infection  


Which patients with gastro should be admitted?

Patients at high risk of dehydration:
- age (< 6 months)
- high frequency of diarrhoea (> 8 per 24 hours)
- vomiting (> 4 per 24 hours) should be observed 

and high risk conditions e.g. short gut