Viral gastroenteritis

Question 1

Viral gastroenteritis is an acute inflammation of the lining of the stomach and small intestine, resulting from viral infection. What is the incidence of VG?

1 - 50 cases per 100,000
2 - 500 cases per 100,000
3 - 5000 cases per 100,000
4 - 50,000 cases per 100,000

Answer 1

3 - 5000 cases per 100,000

Affects males and females equally

The most common cause of acute diarrhoea in the general population contracted by person to person contact

Question 2

Viral gastroenteritis (VG) can occur at any age, but what is the peak age that VG occurs?

1 - 1-4 y/o
2 - 10-20 y/o
3 - 30-40 y/o
4 - >65 y/o

Answer 2

3 - 30-40 y/o

In children most common age is 6-24 months

Most common in winter and spring

Question 3

All of the following organisms can cause viral gastroenteritis (VG). Which of the following is the most common cause of VG in children and adults?

1 - rotavirus
2 - sapovirus
3 - novovirus
4 - adenovirus

Answer 3

3 - novovirus

Question 4

All of the following organisms can cause viral gastroenteritis (VG). Which of the following used to be the most common cause of VG in children?

1 - rotavirus
2 - sapovirus
3 - novovirus
4 - adenovirus

Answer 4

1 - rotavirus
- causes more prolonged infection when compared to other viruses

Typically all children in the UK will have VG before their 5th birthday

Bacteria and parasites can also cause this

Question 5

Which of the following viruses is commonly associated with outbreaks in nurseries and paediatric wards causing viral gastroenteritis?

1 - rotavirus
2 - sapovirus
3 - novovirus
4 - adenovirus

Answer 5

4 - adenovirus

Typically called enteric adenovirus

Question 6

Which of the following is NOT a common risk factor for developing viral (VG) gastroenteritis?

1 - exposure to contaminated food and 2 2 - exposure to contaminated water
3 - close contact with an infected persons
4 - good hygiene
5 - immunocompromised

Answer 6

4 - good hygiene

Typically poor hygiene causes VG

Question 7

Which of the following does NOT typically occur during viral gastroenteritis?

1 - ingestion of virus
2 - virus infects enterocytes throughout whole of the GIT
3 - virus replicates in enterocytes
4 - virus disrupts absorption and secretion and electrolytes (specifically chloride) flood into lumen
5 - viral enterotoxins secreted
6 - malabsorption and osmotic diarrhoea

Answer 7

2 - virus infects enterocytes throughout whole of the GIT

Typically only affects upper GI

Question 8

Viral gastroenteritis typically self limiting. How long does it normally last for?

1 - <24h
2 - <72h
3 - <7 days
4 - <14 days

Answer 8

4 - <14 days

Question 9

In viral gastroenteritis, is a high or low fever common?

Answer 9

• low grade fever

Bacteria typically cause a high grade fever

Question 10

Acute diarrhoea is a common symptom in viral gastroenteritis. How many times must an individual pass stools to be diagnosed with acute diarrhoea?

1 - >3/day
2 - >5/day
3 - >7/week
4 - >10/week

Answer 10

1 - >3/day

Typically watery in nature

Question 11

Acute diarrhoea is a common symptom in viral gastroenteritis. Does this present rapidly or have an insidious nature?

Answer 11

• rapid onset

Question 12

In acute diarrhoea, if blood is present in stool in viral gastroenteritis, is this likely to be due to bacteria or a virus?

Answer 12

• bacteria

If blood in the stool suspect Shiga-toxin producing E-coli or Campylobacter infection

Question 13

In addition to acute diarrhoea, a common symptom in viral gastroenteritis, which of the following symptoms is NOT common?

1 - blood in stool
2 - vomiting and nausea
3 - abdominal pain
4 - mild fever
5 - mucus

Answer 13

1 - blood in stool
- typically occurs if cause is bacterial, rather than viral.

Mucus is more common in bacterial, but can also present in viral

A short viral prodrome may occur prior to any symptoms of viral gastroenteritis

Question 14

A common clinical finding in patients with viral gastroenteritis is dehydration. Which of the following is NOT a sign of dehydration?

1 - dry mucous membranes
2 - tachycardia
3 - hypertension
4 - thin, thready pulse
5 - reduced urine output
6 - reduced skin turgor and sunken eyes

Answer 14

3 - hypertension

Typically causes hypotension

Question 15

A common clinical finding in patients with viral gastroenteritis is dehydration. Which of the following does NOT increase the risk of dehydration?

1 -year of age
2 - low birth weight infants
3 - ≥ 6 diarrhoeal stools in 24hours
4 - ≥ 3 vomiting in the last 24hours.
5 - breastfeeding infants
6 - malnutrition
7 - immunosuppression.

Answer 15

5 - breastfeeding infants

Stopping breastfeeding is a risk factor and a major concern

Question 16

Which of the following is most effective when diagnosing viral gastroenteritis?

1 - U&Es
2 - FBC
3 - Clinical diagnosis
4 - stool culture

Answer 16

3 - Clinical diagnosis
- examination and history

Stool culture is not common, unless the following are present:

• Persistent diarrhoea >14 days
• Blood or pus in the stool
• Suspicion of non-viral gastroenteritis
• History of recent hospitalisation and antibiotic therapy
• Recent foreign travel history

Question 17

All of the following could be a differential for viral gastroenteritis, but which is least likely?

1 - Bacterial gastroenteritis
2 - Food poisoning
3 - Clostridium difficile infection
4 - IBD
5 - Cholecystitis
6 - IBS
7 - Coeliac disease
8 - Hyperthyroidism

Answer 17

5 - Cholecystitis

Question 18

Viral gastroenteritis is typically self-limiting and lasts <14 days. Are patients normally treated at home or admitted to hospital?

Answer 18

• managed at home

Plenty of fluids and non-fatty meals and advise on good hygiene to reduce spread

Question 19

In a patient who has been identified as not being dehydrates with viral gastroenteritis they should be advised to do all of the following except which one?

1 - drink fruit juices and carbonated drinks to help increase glucose
2 - continue breastfeeding
3 - increase overall fluid intake
4 - oral rehydration solution as supplement fluid if at risk of dehydration

Answer 19

1 - drink fruit juices and carbonated drinks to help increase glucose

These can worsen diarrhoea and therefore dehydration

Oral rehydration solution contains glucose and salts (Na+ and K+Cl-)

Question 20

In a patient who has been identified as clinically dehydrates with viral gastroenteritis they should be advised to do all of the following except which one?

1 - give fluid deficit replacement (based on 5% bodyweight)
2 - give maintenance fluids
3 - continue breastfeeding
3 - always use a nasogastric tube
4 - supplement with oral rehydration solution

Answer 20

3 - always use a nasogastric tube

May be used if child is vomitting, but not always

Question 21

If a patient goes into shock due to dehydration, how much balanced crystalloids or 0.9% saline solution should they be given?

1 - 1ml/kg boluses
2 - 10ml/kg boluses
3 - 25ml/kg boluses
4 - 50ml/kg boluses

Answer 21

2 - 10ml/kg boluses

Do not use dextrose-based solutions for volume replacement as this can cause hyponatraemia and hyperglycaemia, which may worsen neurological outcome.

Question 22

The formula for fluid maintenance is for a child weighing <10kg is:

<10kg: 100 mL/kg fluids per day

What is the fluid maintenance that would be needed for a 6.4kg child?

1 - 6.4ml/kg fluids per day
2 - 64mL/kg fluids per day
3 - 640mL/kg fluids per day
4 - 6400mL/kg fluids per day

Answer 22

3 - 650mL/kg fluids per day

Weight = 6.4kg
Fluid - 100ml per kg
6.4 x 100 = 640ml/day

So 640ml over 24h = 27ml/hour or 0.45ml/min

Question 23

The formula for fluid maintenance is for a child weighing between 10-20kg is:

10–20kg: 1000 mL + 50 mL/kg/day for each kg over 10kg

What is the fluid maintenance that would be needed for a 18.5kg child?

1 - 14.25ml/kg fluids per day
2 - 142.5mL/kg fluids per day
3 - 1425mL/kg fluids per day
4 - 14,250mL/kg fluids per day

Answer 23

3 - 1425mL/kg fluids per day

Weight = 18.5kg
Fluid - 1000ml for first 10kg and then 50ml for each kg up to 10kg.

1000ml + (8.5 x 50) = 1425ml/day

So 1425ml over 24h = 24ml/hour or 0.99ml/min

Question 24

The formula for fluid maintenance is for a child weighing >20kg is:

1500 mL + 20 mL/kg for each kg over 20 kg per day

What is the fluid maintenance that would be needed for a 33kg child?

1 - 17.60ml/kg fluids per day
2 - 176.0mL/kg fluids per day
3 - 1760mL/kg fluids per day
4 - 17,600mL/kg fluids per day

Answer 24

3 - 1760mL/kg fluids per day

Weight = 33kg
Fluid - 1500 for first 20kg and then 20ml for each kg after 20kg

1500ml + (13 x 20) = 1760ml/day

So 1760ml over 24h = 29ml/hour or 1.2ml/min

Question 25

If a patient is dehydrated in paediatrics, we need to calculate their fluid deficit. This can be performed using the following: Fluid deficit (mL) = % dehydration x weight (kg) x 10 Step 1 = Previous weight - current weight Step 2 = (change in weight/previous weight) x 100% = % dehydration Step 3 = (% dehydration x current weight) x 10 If a child weighed 12kg before and now weight 11.5kg, what is their fluid deficit? 1 - 4714ml 2 - 474.1ml 3 - 47.41ml 4 - 4.742ml

Answer 25

2 - 474.1ml Fluid deficit: Previous weight = 12kg Current weight = 11.5kg Weight different = 0.5kg - (0.5/12kg) x 100% = 4.1% dehydration - (4.1 x 11.5) x 10 = 471.5ml Maintenance fluid = - 1000ml + (1.5 x 50) = 1075ml Total fluid prescription is 1075 + 471.5 = 1547ml/day Or 26ml/h or 1.1ml/min

Question 26

Weight is typically used for maintenance fluid and fluid deficits. However, if the weight is not available how much deficit should be presumed in a patient who is clinical dehydrated? 1 - 5% 2 - 5-10% 3 - >10% 4 - 15-20%

Answer 26

2 - 5-10% 0 no clinically detectable dehydration <5% deficit - clinical dehydration( 5%–10% deficit) - shock (usually >10% deficit)

Question 27

If a patient is suspected as having viral gastroenteritis, we can perform all of the following, except which one is typically not performed? 1 - echocardiogram 2 - ABG or VBG 3 - U&Es 4 - CRP 5 - FBC 6 - Stool

Answer 27

1 - echocardiogram - ABG or VBG would most likely show metabolic acidosis - U&Es would show Na+ abnormalities, hypokalaemia and raised urea - CRP may be raised due to infection - FBC may be raised due to leukocytosis - Stool may rule out bacterial cause

Question 28

Viral gastroenteritis is typically self-limiting and lasts <14 days. However, if the patient meets any of the following criteria, EXCEPT which one, they may need fluid resuscitation? 1 - Systolic blood pressure >100 2 - Heart rate >90 3 - Cool peripheries 4 - Respiratory rate >20 5 - PEWS score >5

Answer 28

1 - Systolic blood pressure >100 This would normally be below 100 if dehydrated If needed consider: - Fluid resuscitation - Hospital admission - Enable rehydration and electrolyte replacement - Prevent spread of infection

Question 29

All of the following may need to be admitted to hospital, EXCEPT which one? 1 - unable to to maintain oral intake due to vomiting 2 - elderly individuals >60 years old, who are more at risk of severe dehydration 3 - Abdominal tenderness 4 - Diarrhoea lasting > 3days or more

Answer 29

4 - Diarrhoea lasting > 3days or more Typically, it is if the diarrhoea has lasted >10 days

Question 30

Are antibiotics and anti-virals typically recommended in vial gastroenteritis?

Answer 30

- not recommended Zinc supplementation may help reduce severity in third world countries

Question 31

Following infection with viral gastroenteritis, when can patient be allowed back to work after vomiting and diarrhoea have stopped? 1 - 12h 2 - 48h 3 - 1 week 4 - 2 weeks

Answer 31

2 - 48h

Question 32

There are lots of complications of viral gastroenteritis. Which of the following is the least likely? 1 - dehydration and shock 2 - AKI 3 - lactose intolerance 4 - dehydration and electrolyte disturbances 5 - peptic ulcers

Answer 32

Dehydration and electrolyte disturbances Lactose intolerance caused by inflammation to microvilli reducing reducing the expression of lactase enzymes. Normal diet after an episode of diarrhoea results in a return of foul-smelling loose stool, excessive wind, nappy rash etc. Management: Restart ORT/lactose free milk May need up to 8weeks to heal