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Acute Gastroenteritis is a sudden inflammation of the gastric or stomach mucosa. It is defined as a diarrheal disease of rapid onset involving inflammation of the stomach and intestines, a disturbance in intestinal motility and absorption. It interferes with water and electrolytes absorption and accelerates the exertion of intestinal content
Typically, the illness usually lasts 3-5 days. The hallmark of this disease is stool frequency accompanied by vomiting. This disease is common and a costly clinical problem in children during the first 3 years of life and up to 5 years because children are susceptible to catching germs and diseases and their gastrointestinal tract are not strongly and well developed to fight off certain pathogens. A child will likely experience about 1 to 3 acute diarrheal illnesses. Nearly all diarrheal infections are transmitted via the fecal-oral route. Many bacterial etiologies are also food borne.
Some foreign agent cause symptoms that last longer. Severe diarrhea can be fatal because it causes fluid and electrolyte imbalance in the body which can lead to death if not treated immediately and can cause serious health problems such as organ damage. shock.Symptoms usually appear within 12 to 48 hours after exposure to a gastroenteritis-causing agent and last for 1 to 3 days. or coma—a sleeplike state in which a person is not conscious. Severe dehydration may require intravenous fluids and hospitalization. . In addition. a capillary refill lasting over 2 seconds is a sign of dehydration.
cheeks.SIGNS OF DEHYDRATION IN BABIES AND YOUNG CHILDREN ARE: dry mouth and tongue lack of tears when crying no wet diapers for 3 hours or more high fever unusually cranky or drowsy behavior sunken eyes. or soft spot in the skull .
DEGREE OF DEHYDRATION .
Mild (3-5%) Normal or increased pulse Decreased urine output Thirsty Normal physical exam .
pale . delayed cap refill.tenting. cool.Moderate (7-10%) Tachycardia Little/no urine output Irritable/lethargic Sunken eyes/fontanelle Decreased tears Dry mucous membranes Skin.
Severe (10-15%) Rapid. cold. mottled .testing. weak pulse Decreased blood pressure No urine output Very sunken eyes/fontanelle No tears Parched mucous membranes Skin. delayed cap refill.
and radiation therapy.the person eats food that is contaminated with disease-causing microorganisms that are irritating or too highly seasoned.1. bile reflux. other non-steroidal anti-inflammatory drugs. Other causes of acute gastroenteritis include use of aspirin.2 CAUSES Acute Gastroenteritis is often caused by dietary indiscretion. .
giving emphasis on the main cause.These cause the irritation of the GI wall. fever and rare episodes of chills. nausea and vomiting. . which includes increase in white blood cell count. This then leads to the presence of manifestations of inflammation. causing an inflammatory response. which is ingestion of contaminated food.
as well as factors and substances produced by WBC’s.Nausea and vomiting are neurotoxic effects of toxins. if not addressed could lead to fluid and electrolyte imbalance. . which has systemic direct effect in the GIT. This.
These are usually the manifestations seen in acute gastroenteritis. the inflammation of the GI lining worsens and could lead to erosion of the mucosal wall and blood vessels. If the disease is left untreated or is chronic in duration. .
This causes bleeding which is manifested as blood streaked stool or melena. When the erosion is on the upper tract of intestine it causes hematemesis. This could lead to hemorrhage, and eventually, anemia, with signs and symptoms as weakness, paleness, diaphoresis and dizziness.
The untreated could cause hypovolemic shock with manifestations as RR, PR, BP, cold clammy, palpitation, and diaphoresis.
On the other hand, the erosion of the GI lining could lead to perforation. This causes its contents to leak out and lead to pancreatitis and paralytic ileus.
Many types of viruses can cause gastroenteritis . Viral gastroenteritis is a leading cause of severe diarrhea in both adults and children.CAUSATIVE AGENT VIRAL Viruses cause about 70% of episodes of infectious diarrhea in children both in the developed and developing world.
single stranded RNA virus associated with enteric infections in several species including cattles. non enveloped. •Astrovirus– a genus in the family Astroviradae. . small. the leading cause of severe gastroenteritis in children.THE MOST COMMON ONES ARE: •Rotavirus. sheep and dogs.
Symptoms of viral gastroenteritis usually appear within 4 . •Norovirus (also called Norwalk-like virus). keratoconjunctivitis and nasopharyngitis.adenovirus – produces gastroenteritis Clinical Diarrhea.48 hours after exposure to the contaminated food or water.typical infection with other adenoviruses.These viruses are often found in contaminated food or drinking water. It is common among schoolage children. Enteric .
In children bacteria are the cause of about 15% of cases.BACTERIAL In the developed world is the primary cause of bacterial gastroenteritis with half of these cases associated with. .
. If food becomes contaminated with bacteria and remains at room temperatures for a period of hours. Escherichia Coli and Campylobacter.The most common types are Salmonella. Shigella. the bacteria can multiply and increase the risk of infection in those who eat the food.
seafood.Some foods commonly associated with illness include raw or undercooked meat. and fruit and vegetable juices. and eggs. raw sprouts. unpasteurized milk and soft cheeses. chicken. .
Infants can carry these bacteria without developing symptoms. is usually a type of bacterial gastroenteritis .
.PROTOZOAL A number can cause gastroenteritis. most commonly and . These as a group make up about 10% of cases in children.
TRANSMISSION Transmission may occur via consumption of contaminated water. In places with wet and dry seasons. and this correlates with the time of outbreaks. water quality typically worsens during the wet season. or when people share personal objects. .
.Bottle-feeding of babies with improperly sanitized bottles is a significant cause on a global scale. in crowded households. Transmission rates are also related to poor hygiene. especially among children.
adults may carry certain organisms without exhibiting signs or symptoms.and in those with pre-existing poor nutritional status. After developing tolerance. and thus act as natural reservoirs of contagion. .
1.3 PREDISPOSING AND PRECIPITATING FACTORS Age Lifestyle Socio-cultural Poor hygiene .
1.4 SIGNS AND SYMPTOMS Diarrhea Vomiting Fever Weakness Irritability Dehydration .
TREATMENT AND MANAGEMENT
- The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by oral rehydration therapy although intravenous delivery may be required if there is a decreased level of consciousness or dehydration is severe.
ORT such as those made from wheat or rice may be superior to simple sugar-based ORT. Sugary drinks such as soft drinks and fruit juice are not recommended in children under 5 years of age as they may increase diarrhea.
water may be used if specific ORT are unavailable or not palatable. A nasogastric tube can be used in young children to administer fluids.
.It is recommended that breastfed infants continue to be nursed per usual and that formulafed infants continue their formula immediately after rehydration with ORT.DIETARY .
Children should continue their usual diet during episodes of diarrhea with the exception that foods high in simple sugar should be avoided.Lactose-free or lactosereduced formulas usually are not necessary. .
toast and tea) is no longer recommended.The BRAT diet (bananas. applesauce. rice. . as it contains insufficient nutrients and has no benefit over normal feeding.
.Some probiotics have been shown to be beneficial in reducing both the duration of illness and the frequency of stools. Fermented milk products (such as yogurt) may also be beneficial.
Zinc supplementation appears to be effective in both treating and preventing diarrhea among children in the developing world. .
Antibiotics are usually used for gastroenteritis.ANTIBIOTICS . . although they are sometimes recommended if symptoms are severe or a susceptible bacterial cause is isolated or suspected.
Pseudomembranous colitis.If antibiotics are decided on. . a macrolide such as azithromycin is preferred over a flouroquinolones due to the higher rates of resistance to the latter.
is managed by discontinuing the causative agent and treating with either metronidazole or v ancomycin. .usually caused by antibiotics use.
clinical experience. . has shown this to be unlikely.ANTIMOTILITY .Antimotility medication has a theoretical risk of causing complications. however. They are thus discouraged in people with bloody diarrhea or diarrhea complicated by a fever.
an opoid analogue.Loperamide. Loperamide is not recommended in children as it may cross the immature blood brain barrier and cause toxicity. is commonly used for the symptomatic treatment of diarrhea. .
.Bismuth subsalicylate. can be used in mild to moderate cases. an insoluble complex of trivalent bismuth and salicylate.
.National According to Department of Health in the Philippines. incidence rate of Acute Gastroenteritis belongs to the top 10 leading cause of infant mortality and morbidity rate.PREVALENCE RATE .
2006 .INFANT MORTALITY and MORBIDITY: TEN (10) LEADING CAUSES NUMBER AND RATE/per 1000 live births AND PERCENTAGE DISTRIBUTION Philippines.
Respiratory Number Rate Percent 3.194 1.Cause 1.9 14.0 .7 distress of newborn 2.4 11.Bacterial sepsis of newborn 2.400 1.
9 1.947 1.3.4 . Pneumonia 4.Disorders related to short gestation and low birth weight . not elsewhere classified 1.0 7.608 1.2 8.
Congenital malformations of the heart 1. Congenital pneumonia 1.5 6.8 5.409 0.290 0.8 6.9 .5.
7 5.8 .046 0.145 0.3 8.7. Other congenital malformation 1.6 4. Neonatal aspiration syndromes 1.
005 0. Intrauterine hypoxia and birth asphyxia 10.6 4.Diarrhea and gastro-enterities of presumed infectious origin 1.6 984 0.6 4.9.5 .
7 PREVALENCE RATE LOCAL ACUTE GASTROENTERITIS AT LAOAG CITY GENERAL HOSPITAL (LCGH) JANUARY-MAY 2012 .1.
Under 1 1-4 5-9 10-14 15-19 20-44 45-64 = >65 total TOTAL M F M F M F M F M F M F M F M F M F Jan. 3 2 2 4 2 1 1 2 3 9 2 2 1 2 15 21 36 Feb 3 1 5 2 5 1 2 1 2 1 1 3 1 20 8 28 Mar 4 2 7 5 6 1 1 1 1 1 7 6 2 2 2 3 30 21 51 Apr 3 3 9 9 7 3 2 1 1 7 10 5 3 1 31 33 64 May 1 1 13 5 3 1 1 1 2 5 3 2 25 13 38 TOTAL 14 9 36 25 23 5 6 3 3 6 21 26 9 13 9 9 121 96 217 .
Based on this data. . occurrence of AGE is highest in total in the male population of 121 from under 1 to over 65 years of age.ANALYSIS: The data above shows the prevalence rate for AGE taken from Laoag City General Hospital from January to May of 2012.
The overall total prevalence rate from January to May 2012 is 217 both male and female. This concludes that AGE can affect any age but most frequent in children at the age 1-4 years old. . from age 1-4 years old males and 25 in females. The highest incidence of AGE for 2012 so far is 36.
II. ANATOMY AND PHYSIOLOGY .
The stomach is an enlarged segment of the digestive tract in the left superior portion of the abdomen. . It lies obliquely from left to right across the upper abdomen directly beneath the diaphragm.
Anatomically. a giant pear. the stomach is divided into the fundus. and the pyloric antrum or pylorus. . the body. the stomach resembles a J-shaped tube. The normal capacity of the stomach is 1-2 liters.When empty. a when full.
.The concave lesser curvature forms the upper right border of the stomach and the convex greater curvature forms the left and lower borders. Sphincters at each end of the stomach regulate inflow and outflow.
. The area of the stomach into which the cardiac sphincter opens is known as the cardiac region.The cardiac sphincter or lower esophageal sphincter (LES) allows foods to flow into the stomach and prevents reflux of the gastric contents into the esophagus.
.The terminal pyloric sphincter relaxes to permit food to enter the duodenum. and when contracted prevents backflow of the intestinal contents of the stomach.
The pyloric sphincter is of particular clinical interest because obstructive narrowing (stenosis) may occur as a complication of peptic ulcer disease. .
Pyloric stenosis or pylorospasm results when hypertrophied or spastic muscle fibers surrounding the opening fail to relax sufficiently to permit food to pass easily from the stomach to the duodenum. .
The serosa. is a part of the visceral peritoneum. The two layers of the visceral peritoneum come together at the lesser curvature of the stomach . or outer layer.The stomach is composed of four layers.
the lesser omentum .and the duodenum and extend upward to the liver. Peritoneal folds reflected from one organ to another are distinguished as ligaments. forming the lesser omentum. Thus.
dropping over the intestines like a large apron.(also known as the hepatogastric and hepatoduodenal ligaments) suspense the stomach along its lesser curvature to the liver. the peritoneum continuous downward as the greater omentum. . At the greater curvature.
.The muscularisis composed of 3 layers of smooth muscles . and an inner oblique layer. an outer longitudinal. This unique arrangement of fibers provides the variety of contractions necessary to break food into the parietal cells. and propel it into the duodenum. chum and mix it with gastric juices. a middle circular layer.
blood vessels and lymph channels. .The submucosa is composed of loose areolar tissue that connects the muscularis and mucosal layer. It permits the mucosa to move with peristaltic motion. This layer also contains the nerve plexuses.
compose of parasympathetic nerve fibers and cell bodies are found in the submucosa and muscularis layers. Together. the nerve plexuses of both layers compose the intramural plexuses. which extremely important for control of digestive tract functions. .Nerve plexuses.
the inner layer of the stomach. . is arranged in longitudinal folds called rugae. which allow for distention as the stomach becomes filled with food.The mucosa. Several types of glands are located in this layer and are categorized according to anatomic portion of the stomach in which they are located.
.Cardiac glands lie near the cardiac orifice and secrete mucus. The fundicor gastric glands are located in the fundus and over the greater part of the stomach. Gastric glands have three main types of cells.
The Zymogenic or chief cells secrete pepsinogen. Pepsinogen is converted into pepsin in acid environment. . Intrinsic factor is necessary for the absorption of vitamin B12 in the small intestine. Parietal cells secrete hydrochloric acid and intrinsic factor.
Gastrin stimulates the gastrin glands to produce hydrochloric acid and pepsinogen.Mucous cells found in the neck of the fundic or gastric glands secrete mucous. The hormone gastrin is produce by G cells located in the pyloric region of the stomach. .
DIGESTIVE AND SECRETORY FUNCTIONS Digestion of protein by pepsin and HCl is begun. digestion of starches and fats by gastric amylase and lipase is of little importance in the stomach. .
Intrinsic factor secretion enables the absorption of Vitamin B12 from the distal small bowel to take place.Gastrin synthesis and release are affected by ingestion of protein. distention of the antrum. . alkalinization of the antrum and vagal stimuli.
.Mucus secretion forms a protective shell for the stomach as well contributing to lubrication of food easier transport.
this is mediated by the vagus nerve and induced by gastrin. adapts to increased volume without an increase in pressure by receptive relaxation of the smooth muscle.MOTOR FUNCTIONS Reservoir function stores until it can be partially digested and moved on in GI tract. .
peristaltic contractions controlled by a basic intrinsic electrical rhythm.Mixing function breaks food into small particles and mixes it with gastric juice through contractions of muscular coat. .
which is influenced by viscosity. osmotic activity and physical state. drugs and exercise. acidity. as well as by emotions. gastric emptying is controlled by nervous and hormonal factors. volume. .Gastric emptying function controlled by opening of pyloric sphincter.
PERTINENT DATA .III.
DATE OF BIRTH: . Laoag City January 01. 2011 AGE: SEX: ADDRESS: Brgy.NAME: Christyfanie Parillo Samonte 19 months old Female 27.
: 24296 .PLACE OF BIRTH: Laoag City TYPE OF DELIVERY: NSVD RELIGION: Roman Catholic HOSPITAL NO.
CHIEF COMPLAINTS: weakness. loose bowel movement. fever INITIAL DIAGNOSIS: AGE with moderate signs of dehydration FINAL DIAGNOSIS: AGE with dehydration corrected .
ATTENDING PHYSICIAN: Rodrigo L. . DATE OF ADMISSION: July 27. Catcatan Jr. 2012 TIME OF ADMISSION: 5:30 PM DATE OF DISCHARGE: July 29. 2012 TIME OF DISCHARGE: 1:45 PM Dr.
Admitting vital signs TEMP: 40°c PR: 148 bpm RR: 58 bpm WT: 9 kgs. .
FAMILY HEALTH HISTORY .IV.
FAMILY BACKGROUND .A.
Attai nment Eugenio Samonte Jr.Name Relationship to Age the Client Sex Civil Status Religion Occupation Educ. e Catholic . High school e Jerry Clemente Lolo 36 Male Single Catholic Roman Catholic store owner Unemployed Graduate College Graduate Stephanie Samonte Christyfanie Mother 16 Fem ale Single Roman Catholic Roman N/A 3rd H. Mila Samonte Lolo 50 Male Deceased Roman Catholic N/A College Graduate Lola 51 Femal Widow Roman House keeper. yr Self 19 Femal N/A N/A N/A Samonte mos.S.
Christyfanie’s mother Stephanie. a housekeeper and a sari sari store owner. Her lola Mila. is 16 years old with a 3rd year high school completion. Lolo Jerry Clemente. is lola Mila’s brother.Christyfanie belongs to an extended family consisting of 4 members. high school graduate. . is a 51 years old widow.
They are currently living in Brgy. single male. . Their home is a bungalow style made out of concrete with a shared living space of about 10x25ft.He is 36 years old. unemployed with a college degree. 27. Laoag City.
Mila’s husband Eugenio Samonte Jr. the family became a matriarchal family structure which is headed by Mila. died 5 years ago from a head injury. Since then.. She is the only breadwinner and decision maker for the whole family. .
all soul’s day and Saint Joseph feast even though they are not a devout catholic.As far as religious belief. the family celebrates religious holidays such as the holy week. .
00 per month.000. the source of income comes solely from Mila’s sari sari store which generates about Php 6. .FAMILY EXPENSES Although the family has no formal occupation.
Mila actually went to ask for help at their barangay. was when the baby was hospitalized. One time for example. .Stephanie said that their source of income is enough to sustain their needs even though there are moments when the family runs out of money.
Stephanie and her baby. Christyfanie. Mila. are still financially dependent on her mother. According to Stephanie. the family income is spent on the following each month: .
) .00 for electric bill Php 500. clothes. meat and rice Php 700.Php 1. fish.00 for baby supplies (diapers.500. which includes vegetables. etc.000.00 for Nawasa Php 1.00 for food.
00 for Stephanie’s cell phone Php 250.00 savings or extra cash .Php 1.00 for medical expenses Php 200.00 for transportation Php 300. and Php 100.00 for miscellaneous expenses.00 for the sari sari store inventory (can goods and noodles) Php 250.00 for wilkins mineral water for the whole family and Php 100.000.
00 Php 300.00 25 12 8 17 17 4 3 MEDICAL EXPENSES TRANSPORTATION MISC.000.00 % Monthly expenses FOOD ELECTRIC BILL NAWASA WATER BABY INVENTORY WILKINS CELL PHONE Php 1.00 4 3 5 2 TOTAL MONTHLY EXPENSES: Php 6000.00 Php 700.00 Php 250.00 Php 100.MONTHLY INCOME Php 6.00 Php 500.00 Php 200.00 Php 1000.00 .00 Php 1000.500.00 Php 200. SAVINGS Php 250.
5% 3% WILKINS 4% SAVINGS 2% FOOD 25% INVENTORY 17% BABY 17% ELECTRIC BILL 12% NAWASA 8% .monthly expenses MEDICAL EXP 4% TRANS. CELL PHONE 3% MISC.
B.FAMILY HEALTH HISTORY .
Pechay . stated that her grandfather Guillermo Parillo was diagnosed with asthma at the age of 70 at Provincial Hospital. His physician was Dr. is a 19 months old female living with her family in Laoag City. Her grandmother Mila Samonte.Our patient Christyfanie Samonte. Ilocos Norte.
. Guillermo died from asthma at the age of 80 in the year 2000 at Mariano Marcos Memorial Hospital and Medical Center at Batac. Ilocos Norte.Mila does not remember the medications he took during his illness.
was diagnosed with DM TYPE II in the United States. Mila does not remember Florentina’s medications and who her physician was.Mila’s mother Florentina Fajardo. When her mother arrived in Philippines. Castillo was her physician . she continued her medical check-up at Our Lady of Fatima Clinic and Hospital. Dr.
She said she used it as a way to monitor her condition to determine whether she would take her medications or not. .Florentina was using a glucometer to monitor her blood sugar level.
she felt much better than before even though she still experienced a low blood pressure. Gertes was her physician at Gertes Hospital. SG-Gluthergen was her prescribed medication. 1 week after hospitalization. Dr. . She was confined for 3 days in the hospital.Mila Samonte herself was diagnosed with low blood pressure at a young age during high school. According to Mila.
taken once a day. she to use OTC drugs such as SGGluthergen for mild symptoms with Revicon forte multivitamins tablets. she would take twice the dosage of the OTC and the multivitamins. When her condition would get worse. .To relieve her condition.
His doctor administered Calciblock for 1 month. Jerry also used to smoke 2 packs of marlboro red per day for 6 years during college. . used to drink alcohol such as beer at 6 bottles per day and gin at 2 bottles per week.Jerry Clemente who is the brother of Mila Samonte. 27 Laoag City 2 years ago. He was diagnosed with high blood pressure at their barangay health center in Brgy.
After that.Jerry stopped after one month with the medication and maintained his prescribed diet of low fat and low sodium food only. Jerry doesn’t have any known allergies. Jerry was prescribed Maalox for 1week. his gastritis occurred only once in a while and was managed it by eating sky flakes plus taking Maalox to relieve the condition. Deborah Dela Cruz. . he encountered gastritis which was diagnosed by Dr. After 6 months from his diagnosis of High Blood Pressure. As of now.
.Stephanie. Gertes.N. who is the mother of Christyfanie. and was admitted for two days with treatment IV fluid and medications which she can’t remember. was hospitalized when she was in sixth grade at Gertes hospital. She was diagnosed with gastritis by Dr. San Nicolas I.
. she would take kremil-s as OTC drug along with sky flakes. when times she experienced stomach pain. Gertes then prescribed her with Maalox for 3 days. twice daily. avoid spicy and fatty foods.Dr. and eat small frequent meals to prevent the recurrent of the gastritis. She was advised to minimized her consumption of soft drinks. After that. Now.
has not completed her immunizations. She added that back in her childhood days. Mila said that she has only gotten one vaccination so far on her arm. she believes that the vaccines we get now might not have been available back then. The same is true for her brother Jerry. Stephanie on the other hand. the family had already received their immunizations. .Based on our interview.
She said she had taken her BCG. . she had already completed her immunization such as BCG (Bacillus Calmette-Guerin) and Hepatitis B vaccine which were given at birth. and believes that she had taken most of the initial vaccines given at school. DPT (Diptheria Pertusis Tetanus) and Oral Polio Vaccine were administered 6 weeks after her birth. For Christyfanie.
After 3 days.The family is superstitious and believes in ―albularios‖. At one time. her condition didn’t change so she decided to go to an ―albularyo‖. The ―albularyo‖ gave her ―pauli nga lana‖ and advised her to boil guava and avocado leaves for her bathing. she she followed it for 3 days and her condition got better. At that point they gave her medications which she’s unable to remember the medications. Mila went to the health center for check-up when she said ―nagbudo-budo toy imak‖. .
they were children Mila would use moringa oleifera or ―malungay‖ extract as a topical application for her injuries or bruises, and discovered that it was a very effective cure.
C.PAST HEALTH HISTORY
Christyfanie is the first and only baby of Stephanie and her boyfriend Christopher Cacaluan. Christyfanie was born at GRAMH on January 1, 2011 through normal spontaneous vaginal delivery (NSVD).
.Like other children.1ml every 4hours and Myracof syrup for cough and colds. Christyfanie already had measles when she was 9 months old and was vaccinated at that point. cough and colds. With fever. Christyfanie had gone through many common ailments such as fever. As far as communicable diseases. the mother would usually give her baby OTC drugs such as Tempra .
. Christyfanie’s mother concluded that her baby had never experienced any major injuries and had never been hospitalized before.The mother managed her baby’s illness by dressing her with a long black shirt believing that measles will easily fade.
PRESENT HEALTH HISTORY .D.
She can interact with other people. Christyfanie normally use the ―palanggana‖ as bathtub for her to swim in. During bathing. .Christyfanie is usually a playful child. and can play alone while her mother is doing household chores.
her mother and her lola observed that Christyfanie was experiencing frequent watery stools with a yellowish color at 6 pm just last July 26. But before that.On occasion. . she would drink small amounts of water from bathing. Christyfanie ate 3 pieces of fish crackers. a small amount of pancit and a snack in the morning. One day prior to admission.
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