ACUTE

GASTROENTERIT
IS

Acute Gastroenteritis
(AGE)
Inflammation of the mucosa of the stomach

and small intestine

Causes
Viral (70%)
Rotavirus most common cause of
gastroenteritis in children
Norovirus leading cause among adults
Adenovirus
Astrovirus

Bacterial (10-20%)
Clostridium difficile
Staphylococcus
Campylobacter jejuni
E. coli
Salmonella
Shigella

Parasitic (<10%)
- Guardia lamblia
- Entamoeba histolytica
- Cryptosporidium

Other causes
Food allergies: eggs, nuts, milk, and shellfish

are common
Antibiotics: many antibiotics allow bacterial/
fungal overgrowth
Toxins: algal toxin in shellfish, heavy metal
toxins (aluminum, cadmium, arsenic, lead,
mercury)
Medications: side effect of many medications
are diarrhea

Transmission may occur via consumption of

contaminated water, or when people share

personal objects

Differential Diagnosis
Appendicitis- may present with

vomiting, abdominal pain, and small

amount of diarrhea
Diabetic ketoacidosis- presents with
abdominal pain, nausea and vomiting
Small bowel obstruction- presents
with vomiting (bile-stained) and
diarrhea

Stool samples - for microscopy (include ova, cysts and

parasites), culture and sensitivity. Usually samples are

not required but should be sent for microbiological
investigation in outbreaks - eg, in schools, or if:
Septicemia is suspected.
There is blood and/or mucus in the stool.
The child is immunocompromised.
The child has recently been abroad.
The diarrhea has not improved by day 7.
There is uncertainty about the diagnosis of gastroenteritis.

Blood tests - FBC, renal function and electrolytes for

patients in the hospital setting.

Other tests will depend on the individual case and the
need to rule out other possible diagnoses.

MANIFESTATIONS
Diarrhea sometimes accompanied by

vomitting
Crampy pains in abdomen
fever
headache
aching limbs
tiredness and general body weakness
incontinence
increased WBC count

COMPLICATIONS
DEHYDRATION
electrolyte disturbance
SHOCK

Arrange emergency transfer to

secondary care:
Decreased level of consciousness.
Pale or mottled skin.
Cold extremities.
Decreased level of consciousness.
Tachycardia.
Tachypnea.
Weak peripheral pulses.
Prolonged capillary refill time.
Hypotension.

Pathophysiology
Risk factors:
-age
-malnutrition

Predisposing factors:
-contaminated food and
water
Ingestion of fecally
contaminated food
and water

Direct invasion of
the bowel wall

Endotoxins are
released
Stimulation and
destruction of
mucosal lining of
the bowel wall

Attempted
defecation
(Tenesmus)

Digestive and
absorptive
malfunction
Excessive gas
formation

Increase
peristaltic
movement

GI distention

Mild diarrhea
(2-3 stools)

Nausea and
vomiting

Fluid and
electrolytes
imbalance
Increased protein
in the lumen
LI is overwhelmed
and unable to
reabsorb the lost
fluid

Secretion of fluid
and electrolytes
in the intestinal
lumen

Intense diarrhea
(>10x)(watery
stool)
Serous fluid
volume deficit

if untreated
Hypovolemic
shock
Death

MANAGEMENT
Monitor fluid intake and output for

replacement of fluids
Increase fluid intake
Rest

MANAGEMENT
stop eating solid foods to let your stomach

settle
avoid dairy products, caffeine, alcohol,
nicotine
avoid sugary, fatty or highly seasoned foods
drink plenty of liquid every day, taking small,
frequent sips, including clear thin broths or
soups, diluted non-caffeinated sports drinks

ease back into eating slowly with bland easy-

to-digest foods such as, crackers, toast,

bananas, rice and potatoes
make sure that you get plenty of rest
AVOID taking non-steroidal antiinflammatory drugs (NSAIDs),
PARACETAMOL

MANAGEMENT
ORAL REHYDRATION THERAPHY
> ORS
> Drink clear liquids only, such as water,

sports drinks (best), fruit juice and dilute tea.

>Drink small quantities of fluids frequently,
such as 2 tablespoons of fluid every 5
minutes.

Use intravenous fluid therapy for

clinical dehydration if:
Shock is suspected or confirmed.
A child with red flag symptoms or signs (see

'Red flags' box, above) shows clinical evidence

of deterioration despite oral rehydration
therapy.
A child persistently vomits the ORS solution,
given orally or via a nasogastric tube.
If there is SEVERE DEHYDRATION

Medications to controldiarrhea:
Loperamide
Diphenoxylate and Atropine

Antibiotics forbacterial
gastroenteritis
Ciprofloxacin
Cefixime
Sulfamethoxazole and Trimethoprim