GASTROENTERITIS SDLP

Question 1

Give a simple definition of gastroenteritis.

Answer 1

An acute infection of the bowel which causes vomiting and diarrhoea

Question 2

List four common symptoms of gastroenteritis.

Answer 2

Vomiting

Diarrhoea

Mild abdominal cramps/pain

Fever

Question 3

List four conditions which can be mistaken for gastroenteritis in children

Answer 3

Intussusception / partial bowel obstruction / strangulated hernia / acute appendicitis

Urinary tract infection / otitis media / pneumonia / sepsis / meningitis

Haemolytic uraemic syndrome / diabetes mellitus

Inflammatory bowel disease

Question 4

Organisms that cause gastroenteritis can be classified under three headings. List each heading and give an example of an organism under that heading.

Answer 4

Virus: Rotavirus / adenovirus

Bacteria: Campylobacter / salmonella / shigella / E coli / clostridium difficile

Protozoan: Giardia, cryptosporidium

Question 5

List six signs and symptoms you may expect to see in an infant that is moderately dehydrated

Answer 5

Decreased urine output

Reduced skin turgor

Dry mucous membranes – minimal or absence of tears

Sunken eyes

Altered conscious state – drowsiness, irritability, difficulty to wake

Sunken fontanelle

Question 6

What would be the significance of a positive result for reducing substances detected in a patient’s bowel action?

Answer 6

Patient is disaccharide or monosaccharide intolerant - Indicates the need for a change in milk formula to one with less sugar content

Question 7

What infection control precautions would you follow when caring for a child with gastroenteritis?

Answer 7

Isolation on enteric precautions (green card), hand-washing +++, use of alcohol hand gel, gown policy, gloves, disposal of contaminated waste and equipment, education of parents and visitors re precautions, transport of patients to other areas within the hospital, cleaning/ disinfection of equipment and room

Question 8

1. How would you explanation gastroenteritis to the parent?

Answer 8

Gastroenteritis is an infectious illness of the digestive system that causes diarrhoea, vomiting and abdominal cramps.

Question 9

2. List the presenting symptoms that would lead you to suspect the child has viral gastroenteritis

Answer 9

Watery, blood-free diarrhoea

Vomiting

Low-grade fever

Question 10

3. What symptoms would make you suspicious that the gastroenteritis is caused by a bacterium not a virus?

Answer 10

Diarrhoea which can contain mucous or blood

Higher fever with bacterial gastroenteritis

Question 11

4. What is the most likely causative organism of viral gastroenteritis?

Answer 11

Rotavirus

Question 12

5. List four alternative diagnosis that may be mistaken for gastroenteritis

Answer 12

Acute appendicitis

Partial bowel obstruction / intussusception

Urinary tract infection

Meningitis and other types of sepsis

Question 13

6. List four signs and symptoms which may lead you to question the diagnosis of gastroenteritis

Answer 13

Abdominal distension

Bile stained vomitus

Fever greater than 39°C

Vomiting in the absence of diarrhoea

Question 14

7. What are some of the important questions that you would ask the mother when taking a history to help identify the cause and severity of the illness?

Answer 14

Has your child recently travelled overseas?

Has anyone in the family experienced the same symptoms recently?

Does your child attend day care?

For how long has your child had diarrhoea and/or vomiting?

When did your child last pass urine? Can you estimate how much? (Damp, wet, soaked)

Did the bowel actions contain mucous and/or blood?

Do you feel your child has lost weight in the last 24 – 48 hours?

Question 15

8. What is the single most important measure in preventing the spread of viral gastroenteritis?

Answer 15

Effective hand washing following a bowel action, after changing nappies and before the preparation of food

Question 16

Sodium depletion in diarrhoea occurs in two ways:

Answer 16

1) From the body in the bowel motions

2) It moves into the intracellular fluid compartment to replace lost potassium to maintain electrical equilibrium

Question 17

Chris, a 2 yr old boy, arrives in the emergency department with a history of vomiting for the last 24 hours. He has a low grade fever is lethargic and miserable. On urinalysis his specific gravity is 1.030 and he has ketones ++ . What does this suggest?

Answer 17

A high specific gravity suggests that Chris is very dehydrated, and ketones suggests that he is not eating or drinking and is breaking down fat for energy.

Question 18

It is now 48 hours since Chris was admitted to the ward. Chris was diagnosed with a viral gastroenteritis and has been steadily improving. Following a breakfast of toast and a drink of milk he has a large episode of loose diarrhoea. What would you like to do now?

Answer 18

Test for reducing substances. If it is positive change to a lactose free milk and low lactose diet.

Question 19

Chris has now been on a low lactose diet and lactose free milk. His diarrhoea has improved. His mother asks when should she start him on his normal diet again. What would you tell her?

Answer 19

Once she has had a follow up appointment with her GP or medical team from PMH they may suggest a trial. This is usually a few weeks after discharge. This would then follow the grading up regime as mentioned on the previous page. One bottle would be offered on the first day. If this is tolerated, two milk drinks would be offered on the second day and so forth. Once tolerated a normal diet may also be reintroduced. If the milk was not tolerated on the first day then to continue with the lactose free milk and low lactose diet for another week and trial it again.

Question 20

Why are children more prone to dehydration than adults?

Answer 20

higher proportion of fluid in the body weight

higher body surface to volume ration

higher metabolic rate

relatively small fluid reserve

Question 21

List six signs and symptoms you may expect to see in an infant that is moderately dehydrated

Answer 21

Decreased urine output

Reduced skin turgor

Dry mucous membranes – minimal or absence of tears

Sunken eyes

Altered conscious state – drowsiness, irritability, difficulty to wake

immature kidneys unable to concentrate or dilute urine efficiently

Question 22

Why is enteral (oral/NG) rehydration favoured over IV rehydration?

Answer 22

It is much safer as it avoids the risks associated with rapid fluid and electrolyte shifts

It corrects acidosis and dehydration quicker than IV fluids

less risk of seizures when correcting hypernatraemia

Oral rehydrating solutions corrects both hypo/hypernatraemia

vomiting settles more quickly	

diarrhoea settles more quickly

appetite returns earlier

Question 23

Why can drinks such as lemonade make diarrhoea worse?

Answer 23

Any fluid with a high solute load (high osmolality) such as juices or soft drinks may increase water loss into the lumen of the small intestine as the fluid shifts across the lumen from a low osmolality to a high osmolality until the solute concentration is equal on both sides.

Question 24

Why can children with gastroenteritis present with metabolic acidosis?

Answer 24

Severe diarrhoea causes an excessive loss of bicarbonate (a base) in the stool, causing an imbalance of acids(more) and bases(less) in the plasma.

Question 25

What causes a disaccharide intolerance following gastroenteritis?

Answer 25

Disaccharide intolerance may occur due to damage to the intestinal lumen which can decrease or destroy the enzyme lactase, which normally breaks down lactose.

Question 26

Why can’t children suffering from a monosaccharide intolerance have glucolect?

Answer 26

Glucolect contains sugars, which can not be digested by children with a monosaccharide intolerance, and can make the diarrhoea worse.

Question 27

Why do children with gastroenteritis need to be weighed before breakfast everyday?

Answer 27

Weight can be indicative of fluid loss or gain in children. By weighing them at the same time everyday we can estimate this gain or loss, and how hydrated or dehydrated a child is.

Question 28

As a staff member what can you do to prevent the spread of gastroenteritis to yourself and other
patients?

Answer 28

Practice hand hygiene

Wear personal protective equipment (gown and gloves)

Nurse the child in a single room (enteric precaution card)