GASTROENTERITIS Charles E. Henley D.O.,M.P.H. Professor and Chairman Department of Family Medicine OSU Center for Health Sciences College of Osteopathic Medicine (10/2002)

Gastroenteritis, 2002 Causative Agents Rotavirus Norwalk virus Enteric Adenovirus

Gastroenteritis, 2002 Causative Agents Rotavirus Sporadic viral infections Most common Affects infants and young children Can be severe

Gastroenteritis, 2002 Causative Agents NORWALK VIRUS Causes epidemic viral gastroenteritis Milder illness Usually self-limiting Affects both children and adults Community outbreaks

Gastroenteritis, 2002 Causative Agents ENTERIC ADENOVIRUS Second most common cause of gastroenteritis Affects younger children

Gastroenteritis, 2002 Clinical Presentation: Symptoms Nausea / Vomiting Cramping abdominal pain Due to excessive fluid Increased peristalsis Absence of blood and fecal Leukocytes Key to differential with bacterial infections

Gastroenteritis, 2002 Physical Signs Voluminous, non-bloody Stools Dehydration Decreased urination Mental status changes Dry mucous membranes Lethargy

Gastroenteritis, 2002 History Daycare Antibiotic Exposure Foods Hospitalize with: Severe dehydration Abdominal tenderness Fever Bloody diarrhea

Gastroenteritis, 2002 Diagnostic Testing Focused Bloody diarrhea? Fecal leukocytes? If non-inflammatory, no culture Lab Tests? Viral Detection? Test for rotavirus

Gastroenteritis, 2002 Management Self limiting course Replace fluids and electrolytes Oral Rehydration (ORT) Mild to moderate dehydration Commercially available ORT Pedialyte (45 meq Na ) Ricelyte (50 meq Na )

Gastroenteritis, 2002 Management Severe Dehydration ORT can be successful IV fluids Shock Uremia Ileus Fluid loss > 10 ml/kg/hr

Gastroenteritis, 2002 WHO Recommendation Recipe for ORT: 3/4 teaspoon salt 4 tablespoons sugar 1 teaspoon baking soda 1 cup orange juice 1 liter clean water

Gastroenteritis, 2002 Refeeding ORT: continue during diarrhea Continue breast feeding Formula fed : Lactose free Start with 1:1 dilution Full strength after hours of ORT

Gastroenteritis, 2002 Refeeding Weaned Children Avoid (24 – 48 hours): Lactose containing foods Avoid caffeine, raw fruits Start refeeding with: Rice, wheat noodles, bananas

Gastroenteritis, 2002 Antidiarrheal Agents Anticholenergic agents Ineffective Contraindicated in children Absorbents agents Kaopectate Do not change duration or fluid loss

Gastroenteritis, 2002 Antidiarrheal Agents Antisecretory Agents Bismuth Subsalicylate (pepto-bismal ) Increases intestinal Sodium and water re-absorption Blocks the effects of enterotoxins

Gastroenteritis, 2002 Antidiarrheal Agents Anti-motility Agents Loperimide Lomotil Avoid in infants and children Worsens bacterial infections

Gastroenteritis, 2002 Food Borne Illness Incidence 6.5 million cases per year 7000 deaths

Gastroenteritis, 2002 Food Borne Illness Etiology Bacterial Staphlylococcus areus Salmonella typhi Clostridium difficile Parasites Giardia lambia

Gastroenteritis, 2002 Etiology Associated with: Undercooked meats Contaminated seafood, water Unrefrigerated foods Treatment Resolves with supportive care Botulism Antiserum to neurotoxin

Gastroenteritis, 2002 AIDS Patients G.I. symptoms are common Etiology Mycobacterium avium Adenovirus Cytomegalovirus Cryptosporidium Isospora belli Camphylobacter jejuni

Gastroenteritis, 2002 AIDS Patients High Risk for: Salmonella Clostridium Due to frequent antibiotic use

Gastroenteritis, 2002 AIDS Patients Treatment Focused on treatable causes of diarrhea Alleviate morbidity Anti-diarrheal agents Prevent fecal/oral spread of enteric pathogens (hospitalized patients )

Gastroenteritis, 2002 Reference Henley, C.E., Gastroenteritis. Manual of Family Practice. Taylor, Robert B., Little, Brown, 2 nd Edition, 2000.