🌚Acute infections. - Strept. Pharyngitis - Pneumonia(lower lobe) (mesenteric adenitis) - Rheumatic fever (peritonitis) - Acute hepatitis. - Acute pancreatitis - Acute pyelonephritis - Acute peritonitis - Acute appendicitis 😮Acute medical conditions - Henoch Schonlein purpura. - Familial mediterranean fever. - Diabetic keto acidosis 😓 Acute intestinal obstruction

Mild = 4-6 motions /day Moderate = 6-10 motions /day Severe > 10 motions /day

- Salmonella - Shigella desentyrie type 1. - Entero invasive E-Coli. - Entero hemorrhagic (Shiga toxin producing) E-Coli

- Shigella (diarrheal type) - Entero pathogenic E-Coli - Entero toxigenic E-Coli - Vibrio cholerae O1. Watery offensive for 2-4 days then turn bloody p Campylobacter jejuni.

🌻Giardia Lambelia - Watery - Offensive - No fever 🌻 Entameaba histolytica - Bloody, may be with tenesmus - No fever usually 😀 Rectal tenesmus is a feeling of incomplete defecation. It is the sensation of inability or difficulty to empty the bowel at defecation, even if the bowel contents have already been evacuated.

Gastrointestinal Flashcards by 🌻 🌻

Causes of vomiting in infants and children

Acute infections
- CNS infections
- Pulmonary infections
- Gastroenteritis
- Acute pyelonephritis
- Sepsis
Metabolic
- Drug poisoning
- Rye’s syndrome
- Diabetic keto acidosis
- Renal failure
- Drugs: e.g. aspirin
Acute intestinal obstruction
* Functional: Paralytic ileus
* Organic:

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Chronic vomiting 🤮

Over feeding
Gastro-Esophageal reflux
Congenital pyloric stenosis
Inborn errors of metabolism/ adrenal insufficiency
Psychogenic

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Acute abdominal pain

🌚Acute infections.

Strept. Pharyngitis
Pneumonia(lower lobe)

(mesenteric adenitis)

Rheumatic fever (peritonitis)
Acute hepatitis.
Acute pancreatitis
Acute pyelonephritis
Acute peritonitis
Acute appendicitis

😮Acute medical conditions

Henoch Schonlein purpura.
Familial mediterranean fever.
Diabetic keto acidosis

😓 Acute intestinal obstruction

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Chronic (recurrent) abdominal pain

Functional

Irritable bowel syndrome

(in 90%; psychic related)

School phobia

Organic

Intestinal parasites e.g. Giardiasis
Chronic diarrhea (and Malabo sorption)
Chronic constipation
Inflammatory bowel disease
H. Pylori infection
Chronic hepatitis
Stones (urinary, biliary)

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Causes of constipation

Anal fissure
Spina bifida
Cretinism
Intestinal obstruction
Habitual constipation
Medications (narcotics)

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Acute infectious diarrhea (Gastro Enteritis)

Gastroenteritis is due to infection acquired through the fecal-oral route or by ingestion of contaminated food or water

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Severity

Mild = 4-6 motions /day
Moderate = 6-10 motions /day
Severe > 10 motions /day

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Causes of Gastroenteritis

Viral (60%)

Examples

Rota virus.
Norwalk like viruses
Adenovirus

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Viral gastroenteritis sx

Age usually less than 2 years.
Common in winter
May be associated upper respiratory tract infections
Pyrexia if present usually (< 38.5 rC).
Diarrhea is: - Mild to moderate.
Transient = (5-7 days)
Watery
Odorless

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Bacterial gastro enteritis sx

Common in summer
With high fever (>38.5 o C)
Cramping abdominal pain
Usually severe diarrhea which may be
Bloody or watery or watery offensive

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Bloody with:

Salmonella
Shigella desentyrie type 1.
Entero invasive E-Coli.
Entero hemorrhagic (Shiga toxin producing) E-Coli

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Watery?

Shigella (diarrheal type)
Entero pathogenic E-Coli
Entero toxigenic E-Coli
Vibrio cholerae O1.
Watery offensive for 2-4 days then turn bloody p Campylobacter jejuni.

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protozoal

🌻Giardia Lambelia

Watery
Offensive
No fever

🌻 Entameaba histolytica

Bloody, may be with tenesmus
No fever usually
😀 Rectal tenesmus is a feeling of incomplete defecation. It is the sensation of inability or difficulty to empty the bowel at defecation, even if the bowel contents have already been evacuated.

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Complications of Gastroenteritis

Dehydration
Shock
Acute renal failure (ARF)
Metabolic Acidosis
Electrolyte disturbance
Convulsions
Bleeding
Persistant diarrhea and eventual Malnutration

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Dehydration

🌻Fluid loss due to vomiting, diarrhea and anorexia (

🤦🏻‍♀️The main cause of death in gastroenteritis

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Shock

🌺Types

Hypovolemic shock with severe dehydration Gram negative septic shock.

🌺Clinically

🥀Decreased peripheral perfusion
 o Skin mottling , capillary refill time >2 secondsȺ o Cold extremities
🥀 Decreased vital organs perfusion
 o Brain p lethargy o Kidney p oliguria
🥀 Hypotension and rapid thready pulse

Acute renal failure (ARF)

Hypovolemia ➡️⬇️ renal blood flow (pre renal failure).

Untreated pre renal failure ➡️ tubular necrosis ➡️ intrinsic renal failure

🥸Clinically

o Oliguria or anuria o Acidotic breathing (Rapid, deep breathing).

Metabolic Acidosis

😃Due to
Loss of bicarbonate in the stool
Acute renal failure
😶Clinically
o Acidotic breathing (rapid deep breathing pattern) o Disturbed consciousness.
o Arterial blood gases (qpH, qPaCO2 , qHCO3 ) -.

Electrolyte disturbance

🌼Hypokalemia: (serum potassium < 3 meq /L) Clinically
- Apathy (disturbed consciousness)

Arrhythmias
Abdominal distension (paralytic ileus)
Atony (Hypotonia).

🌼 Hypocalcemia: p Tetany or Convulsions
🌼 Hypo or hyper natremia: p Convulsions

Convulsions

y Hypoglycemia ; mainly in mal nourished.

y Hypo or Hypernatremia.

y Hypocalcemia
y CNS infections e.g. meningitis or encephalitis may due to shigella or neurotropic virus

Workup of Gastroenteritis

For the cause
-  GSE: Look for mucus, blood, fecal leukocytes, or parasites.

 Stool cultures should be obtained early in the course of diseas.

It is usually indicated in the following 4 conditions: bloody diarrhea,

chronic diarrhea, immunosuppression, & outbreaks of HUS.

 Blood tests e.g. CBP, blood culture, serologic tests, & PCR are

sometimes used for specific pathogens.

For the complications (more important)
- Routine: Blood urea nitrogen, creatinine, sodium ,potassium, and calcium.
- Blood gases p for metabolic acidosis.
- Coagulation profile p PT, PTT, FDPs, platelets for bleeding
- Others: According to clinical suspicion e.g. Abdominal ultrasound /X ray

Treatment of Gastroenteritis

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Electrolyte disturbance

🌼Hypokalemia: (serum potassium < 3 meq /L) Clinically
- Apathy (disturbed consciousness)

Arrhythmias
Abdominal distension (paralytic ileus)
Atony (Hypotonia).

🌼 Hypocalcemia: p Tetany or Convulsions
🌼 Hypo or hyper natremia: p Convulsions

Convulsions

y Hypoglycemia ; mainly in mal nourished.

y Hypo or Hypernatremia.

y Hypocalcemia
y CNS infections e.g. meningitis or encephalitis may due to shigella or neurotropic virus

Workup of Gastroenteritis

1. For the cause - Stool analysis for blood, fecal leucocytes , Rotazyme test,parasites - Stool culture 2. For the complications (more important) - Routine: Blood urea nitrogen, creatinine, sodium ,potassium, and calcium. - Blood gases p for metabolic acidosis. - Coagulation profile p PT, PTT, FDPs, platelets for bleeding - Others: According to clinical suspicion e.g. Abdominal ultrasound /X ray

Treatment of Gastroenteritis

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shigella

Shigella infection occurs essentially through oral contamination via direct fecal-oral transmission, the organism being poorly adapted to survive in the environment. Resistance to low-pH conditions allows shigellae to survive passage through the gastric barrier, an ability that may explain in part why a small inoculum (as few as 100 CFU) is sufficient to cause infection.

Shigella phases

Shigellosis typically evolves through four phases: incubation, watery diarrhea, dysentery, and the postinfectious phase.

Shigella sx

🌻Symptoms include the following: Sudden onset of severe abdominal cramping, high-grade fever, emesis, anorexia, and large-volume watery diarrhea. Seizures may be an early manifestation. Abdominal pain, tenesmus, urgency, fecal incontinence, and small-volume mucoid diarrhea with frank blood (fractional stools) may subsequently occur. 🌻Signs include the following: Elevated temperatures (as high as 106 º F) are documented in approximately one third of cases, and a generally toxic appearance is noticed. Tachycardia and tachypnea may occur secondary to fever and dehydration. Depending on the degree of dehydration, dry mucous membranes, hypotension, prolonged capillary refill time, and poor skin turgor may be present. Abdominal tenderness is usually central and lower, although it may be generalized.

Extra intestinal manifestations of shigel

Major complications are predominantly intestinal (e.g., toxic megacolon, intestinal perforations, rectal prolapse) or metabolic (e.g., hypoglycemia, hyponatremia, dehydration). Bacteremia is rare and is reported most frequently in severely malnourished and HIVinfected patients. Alterations of consciousness, including seizures, delirium, and coma, may occur, especially in children <5 years old, and are associated with a poor prognosis; fever and severe metabolic alterations are more often the major causes of altered consciousness than is meningitis or the Ekiri syndrome, HUS

Shigella tx

ciproﬂoxacin (500 mg twice daily for 3 days) Azithromycin and ceftriaxon