INTRODUCTION Gastroenteritis (also known as gastric flu or stomach flu, although unrelated to influenza) is inflammation of the gastrointestinal tract
, involving both the stomach and the small intestine and resulting in acute diarrhea. It can be transferred by contact with contaminated food and water. The inflammation is caused most often by an infection from certain viruses or less often by bacteria, their toxins, parasites, or an adverse reaction to something in the diet or medication. Current death rates have come down significantly to approximately 1.5 million deaths annually in the year 2000, largely due to the global introduction of oral rehydration therapy and is a leading cause of death among infants and children under 5. At least 50% of cases of gastroenteritis due to foodborne illness are caused by norovirus. Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus and astrovirus. Different species of bacteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, Vibrio cholerae, and others. Some sources of the infection are improperly prepared food, reheated meat dishes, seafood, dairy, and bakery products. Each organism causes slightly different symptoms but all result in diarrhea. Colitis, inflammation of the large intestine, may also be present. Risk factors • • • consumption of improperly prepared foods contaminated water travel or residence in areas of poor sanitation
Infectious gastroenteritis is caused by a wide variety of bacteria and viruses. It is important to consider infectious gastroenteritis as a diagnosis per exclusionem. A few loose stools and vomiting may be the result of systemic infection such as pneumonia, septicemia, urinary tract infection and even meningitis. Surgical conditions such as appendicitis, intussusception and, rarely, even Hirschsprung's disease may mislead the clinician. Endocrine disorders (e.g. thyrotoxicosis and Addison's disease) are disorders that can cause diarrhea. Also, pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should be excluded as possibilities.
then it is important to distinguish between bacterial and viral infections. or inflammatory infections of the colon. In some cases. Other methods. diarrhea and/or vomiting. These children are routinely tested also for norovirus. Diarrhea is common. Pseudomembranous colitis is an important cause of diarrhea in patients often recently treated with antibiotics. whereas blood stained diarrhea may be indicative of bacterial colitis. are used in research laboratories.
Viruses causing gastroenteritis include rotavirus. for example. normally lasting 1–6 days. Bacteria. Viral diarrhea usually causes frequent watery stools. bile can be vomited up. with noninflammatory infection of the upper small bowel. The condition is usually of acute onset. and is self-limiting. see above. norovirus.Bacterial gastroenteritis
For a list of bacteria causing gastroenteritis. Campylobacter. Salmonella.
. Viruses do not respond to antibiotics and infected children usually make a full recovery after a few days.
Symptoms and signs
Gastroenteritis often involves stomach pain or spasms. which is extraordinarily infectious and requires special isolation procedures to avoid transmission to other patients. and may be followed by vomiting. Children admitted to hospital with gastroenteritis routinely are tested for rotavirus A to gather surveillance data relevant to the epidemiological effects of rotavirus vaccination programs.suggesting infection by amoeba. electron microscopy and polyacrylamide gel electrophoresis. adenovirus and astrovirus. Shigella or some pathogenic strains of Escherichia coli[) Fainting and Weakness Heartburn
The main contributing factors include poor feeding in infants.
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Nausea and vomiting Diarrhea Loss of appetite Fever Headaches Abnormal flatulence Abdominal pain Abdominal cramps Bloody stools (dysentery . Shigella and Campylobacter. If gastroenteritis in a child is severe enough to require admission to a hospital. and parasites like Giardia can be treated with antibiotics Traveler's diarrhea is usually a type of bacterial gastroenteritis. even when the stomach is empty.
frequency. examination of stool for Clostridium difficile may be advisable along with cultures for bacteria including Salmonella. Shigella.A child with gastroenteritis may be lethargic. No specific diagnostic tests are required in most patients with simple gastroenteritis. Diagnosing gastroenteritis is mainly an exclusion procedure. poor perfusion and ultimately shock.an organism found in water that causes diarrhea. and description of the patient's bowel movements and if they experience vomiting are also relevant and these question are usually asked by a physician during the examination. Conditions such as appendicitis. Coli infections or parasite infections contacted from beverages or food. sunken eyeballs. suffer lack of sleep. have signs of dehydration (which include dry mucous membranes). bloody stool and diarrhea persist for two weeks or more. no
. During the physical examination. gallbladder disease. a complete medical history and a physical examination. when the symptoms are conclusive. run a low fever. An accurate medical history may provide valuable information on the existence or inexistence of similar symptoms in other members of the patient's family or friends. food preparation habits or storage and medications. complete blood count. Therefore in rare cases when the symptoms are not enough to diagnose gastroenteritis. A complete medical history may be helpful in diagnosing gastroenteritis. Depending on the type of bacteria that is causing the condition. pancreatitis or diverticulitis may cause similar symptoms but a physical examination will reveal a specific tenderness in the abdomen which is not present in gastroenteritis. several tests may be performed in order to rule out other gastrointestinal disorders. the reactions appear in 2 to 72 hours. These include rectal examinations. ova and cysts may also be helpful. Detecting the specific infectious agent is required in order to establish a proper diagnosis and an effective treatment plan. The doctor may want to find whether the patient has been using broad-spectrum or multiple antibiotics in their recent past. glassy eyes. exposure to poisons or other irritants. darkened eye circles. tachycardia. skin color discoloration. Patients who travel may be exposed to E. diet change. electrolytes and kidney function tests. If so. Food poisoning must be considered in cases when the patient was exposed to undercooked or improperly stored food. Swimming in contaminated water or drinking from suspicious fresh water such as mountain streams or wells may indicate infection from Giardia . the doctor will look for other possible causes of the infection. The duration. However. reduced skin turgor.
Gastroenteritis is diagnosed based on symptoms. Campylobacter and enterotoxic Escherichia coli. sunken fontanelles. they could be the cause of an irritation of the gastrointestinal tract. Microscopy for parasites. A complete and accurate medical history of the patient includes information on travel history. If symptoms including fever.
Avoid suspect food or drink. The U.
The primary treatment of gastroenteritis in both children and adults is rehydration. the implementation of a rotavirus vaccine has decreased the number of cases of diarrhea due to rotavirus in the United States Gastroenteritis may be prevented through immunization.e.
Percentage of rotavirus tests with positive results. replenishment of water and electrolytes lost in the stools. Different types of vaccinations are available for Salmonella typhi and Vibrio cholera and which may be administered to people who intend traveling in at-risk areas. by surveillance week. Metoclopramide and ondansetron however may be helpful in children. the vaccines that are currently available are effective only on rotavirual gastroenteritis. The vaccines may however have side effects that are similar to the mild flu symptoms. Thoroughly wash both hands before eating and after using the bathroom or changing diapers. Bleaching soiled laundry and household surfaces may help prevent spreading bacteria. theaters or shopping centers may also help in preventing infection for those who have weak resistance. Doctors recommend that food be properly cooked and stored to prevent gastroenteritis. However. Oral rehydration is the preferred method of replacing these losses in children with mild to moderate dehydration.tests apart from the stool tests are required to correctly diagnose gastroenteritis especially if the patient has traveled to at-risk areas. This is preferably achieved by giving the person oral rehydration therapy (ORT) although intravenous delivery may be required if a
. United States. Viral gastroenteritis is a highly contagious disease and thus avoiding crowded spaces such as markets. i.S. Since 2000.. Food and Drug Administration approved in 2006 a rotavirus called Rotateq that may be given to infants aged 6 to 32 weeks to prevent getting infected with viral gastroenteritis. July 2000--June 2009. The objective of treatment is to replace lost fluids and electrolytes.
Gastroenteritis is usually an acute and self-limited disease that does not require pharmacological therapy.
clinical experience. The BRAT diet (bananas. Complex-carbohydrate-based oral rehydration therapy such as those made from wheat or rice may be superior to simple sugarbased ORS. fewer hospitalizations. therefore substantial amounts of soft drinks. is commonly used for the symptomatic treatment of diarrhea. can be used in mild-moderate cases.
It is recommended that breastfed infants continue to be nursed on demand and that formula-fed infants should continue their usual formula immediately after rehydration with oral rehydration solutions.
. toast and tea) is no longer recommended. Sugary drinks such as soft drinks and fruit juice are not recommended for gastroenteritis in children under 5 years of age as they may make the diarrhea worse. although they are sometimes used if symptoms are severe (such as dysentry) or a susceptible bacterial cause is isolated or suspected. Pseudomembranous colitis. They are thus discouraged in people with bloody diarrhea or diarrhea complicated by a fever. Ondansetron has some utility with a single dose associated with less need for intravenous fluids. The intravenous preparation of ondansetron may be given orally. and other high simple sugar foods should be avoided. Metoclopramide also might be helpful. usually caused by antibiotics use. Children receiving semisolid or solid foods should continue to receive their usual diet during episodes of diarrhea. juice.decreased level of consciousness or an ileus is present. applesauce. however. Loperamide is not recommended in children as it may cross the immature blood brain barrier and cause toxicity. Antimotility agents Antimotility drugs have a theoretical risk of causing complications. Loperamide. However there was an increased number of children who returned and were subsequently admitted in those treated with ondansetron. Bismuth subsalicylate (BSS). a fluoroquinolone or macrolide is often used. and decreased vomiting. Lactose-free or lactose-reduced formulas usually are not necessary. If antibiotics are decided on. is managed by discontinuing the causative agent and treating with either metronidazole or vancomycin. as it contains insufficient nutrients and has no benefit over normal feeding. Plain water may be used if specific ORS are unavailable or not palatable. has shown this to be unlikely.
Antiemetics Antiemetic drugs may be helpful for vomiting in children. an opioid analogue. an insoluble complex of trivalent bismuth and salicylate. Antibiotics Antibiotics are not usually used for gastroenteritis. The practice of withholding food is not recommended and immediate normal feeding is encouraged. Foods high in simple sugars should be avoided because the osmotic load might worsen diarrhea. rice.
Zinc The World Health Organization recommends that infants and children receive a dietary supplement of zinc for up to two weeks after onset of gastroenteritis.5 million deaths annually in the year 2000.
Dehydration is a common complication of diarrhea.
Probiotics Some probiotics have been shown to be beneficial in preventing and treating various forms of gastroenteritis. Fermented milk products (such as yogurt) also reduce the duration of symptoms. mothers should continue breastfeeding. Aetiological agents vary depending on the climate. hygiene and cultural habits are important factors. Though it may increase the diarrhea.6 million deaths in children with most of these occurring in the third world. the principal sugar in milk. causes 111 million cases of gastroenteritis and nearly half a million deaths. A 2009 trial however did not find any benefit from supplementation. Lack of adequate safe water and sewage treatment has contributed to the spread of infectious gastroenteritis. may occur. 82% of these deaths occur in the world's poorest nations. Current death rates have come down significantly to approximately 1. living conditions.
Every year worldwide rotavirus in children under 5. The incidence in the developed world is as high as 1-2. most cases of gastroenteritis are seen during the winter in temperate climates and during summer in the tropics. largely due to the global introduction of oral rehydration therapy.Antispasmotics Butylscopolamine (Buscopan) is useful in treating crampy abdominal pain. In 1980 gastroenteritis from all causes caused 4. however.
. Age. Malabsorption of lactose.5 cases per child per year and is a major cause of hospitalization in this age group. It can be made worse with the withholding fluids or the administration of juice / soft drinks. Furthermore.