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patient profile

Name: Melegrito Romep Jade

Age: 1yr & 4 mos.

Sex: Male

Chief complaint/Reason for admission: Vomiting, loose bowel movement.

Brief history of present illness: 3 days of PTA, 5x/day of having a loose bowel movement.

Moving PTA, consulted @ private medical doctor given


chloromphenicol- Dysochloverine

Persistence of loose bowel mov't (10x/day) & vomiting promted


consult @ ER hence admission & management.

Past history- October 2018-AGE

(+) complete immunization

Family history- No known heredofamilial dse.

Physical assessment:

V/S: BT - 37.1

Wt. 3kg

General survey:weak looking

HEENT:anicteric, selenae, pink palp., dry lips, sunken eyeball

Chest and lung: SCE (-) retractions, clear breath sounds

CVS: AP (-) murmur

Abdo. : Soft (+) tenderness

Admitting Diagnosis : AGE with moderate dehydration


Anatomy and physiology of acute gastroenteritis

DIGESTIVE SYSTEMThe digestive system consists of two linked parts: the alimentary canal and the
accessorydigestive organs. The alimentary canal is essentially a tube, some 9 meters (30 feet) long,
thatextends from the mouth to anus, with its longest section- the intestines- packed into theabdominal
cavity. The lining of the alimentary canal is continuous with the skin, so technicallyits cavity lies outside
the body. The alimentary µtube¶ consist of linked organs that each playtheir own part in digestion:
mouth, pharynx, esophagus, stomach, small intestine, and largeintestine. The accessory digestive organs
consist of the teeth and tongue in the mouth; and thesalivary glands, liver, gallbladder, and pancreas,
which are all linked by ducts to the alimentarycanal.STOMACHIt is a J- shaped enlargement of the GI
tract directly under the diaphragm in the epigastric,umbilical and left hypochondriac regions of the
abdomen. When empty, it is about the size of a

large sausage; the mucosa lies in large folds, called RUGAE. Approximately 10 inches long butthe
diameter depends on how much food it contains. When full, it can hold about 4 L ( 1galloon) of food.
Parts of the stomach includescardiac regionwhich is defined as a position near the heart surrounds the
cardioesophageal sphincter throughwhich food enters the stomach from the esophagus;funduswhich is
the expanded part of the stomach lateral to the cardia region; bodyis the mid portion; and the

pylorus

a funnel shaped which is the terminal part of the stomach. The pylorus is continuous with thesmall
intestine through the pyloric sphincter, or valve.With the gastric glands lined with severalsecreting cells
the zymogenic (peptic) cells secrete the principal gastric enzyme precursor, pepsinogen. The parietal
(oxyntic) cells produce hydrochloric acid, involved in conversion of pepsinogen to the active enzyme
pepsin, and intrinsic factor, involved in the absorption of Vitamin B12 for the red blood cell production.
Mucous cells secrete mucus. Secretions of thezymogenic, parietal and mucus cells are collectively called
the gastric juice. Enteroendocrinecells secrete stomach gastrin, a hormone that stimulates secretion of
hydrochloric acid and pepsinogen, contracts the lower esophageal sphincter, mildly increases motility of
the GI tract,and relaxes the pyloricsphincter. Most digestive activity occurs in the pyloric region of
thestomach. After food has been processed in the stomach, it resembles heavy cream and is
calledCHYME. The chyme enters the small intestine through the pyloric sphincter.

Pathopysiology
The digestive tract plays a key role in the human organism , as it isresponsible for the supply of energy
for the organism to perform its basic functions . To be particular , this system of organs ``takes infood ,
digests it to extract energy and nutrients , and expels theremaining waste (1 . As the digestive tract
processes food and thusinteracts directly with the environment , it can be subject to variousinfections .
For instance , viral gastroenteritis is the ``inflammation of the gastrointestinal tract , an illness of fever ,
diarrhoea and vomitingcaused by an infectious virus , bacterium or parasite ' that affectssmall and large
intestines (2 . A brief comparison of the etiology , pathogenesis and clinicalmanifestation of viral
gastroenteritis to the normal anatomy andphysiology reveals the peculiar features of this disease . To
start with ,this disease affects the normal functioning of such organs as thestomach and the intestines .
As for the physiology , the regular processof digestion consists in passing food along the tract with
breaking downit into smaller elements , so that nutrients are absorbed to the bloodstream . Chemical
fragmentation of large molecules into clusters of smaller ones occurs with the help of special ferments
(enzymes ) and bacteria . After the nutrients are absorbed the food remnants are passedto the large
intestine and then exposed as excrements . Viral gastroenteritis disrupts the regular physiology of
digestion . Thegastrointestinal tract is infected by one of such viruses asrotaviruses , adenoviruses ,
caliciviruses , astroviruses , Norwalk virus ,and a group of Noroviruses (3 . This causes inflammation of
the surfacelayer of the digestive tract . The pathology of this disease presupposesthat these viruses
interfere in the normal bacteria environment , destroy the surface cells of the digestive tract and prevent
normal absorptionof water and sodium during digestion . As a result , the digestion doesnot occur
correctly and the organism does not receive the sufficientquantity of nutrients , as it happens in the
regular case . Thus thesymptom of the disease is weakness , while the children may seemlethargic (2
.Besides as the water balance cannot be maintained , the patients may suffer from dehydration .
Therefore , the sick people are advised tocompensate the loss of fluid in the organism by drinking a lot .
In thehealthy human body the digestion presupposes the absorption of therequired water quantity , so
that the regulation process takes placeautomatically . Viral gastroenteritis also affects the excretion
processes . Among thechief symptoms of this disease are ``poor feeding in infants , vomitingand fever ,
usually rapidly followed by diarrhoea (2 , as well asnausea . In a healthy digestive tract the food passes
through with thehelp of peristalsis , until its remnants are disposed of as feces . In viral gastroenteritis
the rhythmic muscular contraction of the tract isdisrupted , its surface is inflamed , so that the food is
forced back fromthe digestive organs in the form of nausea or vomiting . In most cases viral
gastroenteritis is considered to be a self-limiting disease...