Acute Gastroenteritis (also called Stomach Flu)

• Acute gastroenteritis is a sudden condition that causes irritation and inflammation of the
stomach and intestines or the gastrointestinal tract.
• Viral infection is the most common cause of gastroenteritis but bacteria, parasites, and
food-borne illness (such as shellfish) can also cause acute gastroenteritis.
• Fifty to seventy percent of cases of gastroenteritis in adults are caused by the
noroviruses while rotavirus is the leading cause of infection in children. Staphylococcus
aureus can form a toxin that cause food poisoning while the resident Escherichia coli
can also cause significant problems.
• Many people who experience symptoms of vomiting and diarrhea, which develop from
these types of infections or irritations believe they have food poisoning, and they indeed
have a food-borne illness.
• The severity of gastroenteritis depends on the immune system’s ability to resist and fight
the infection. Electrolytes, especially sodium and potassium may be lost if the client
continue to vomit and experience diarrhea.
• Most people recover easily from a short course of vomiting and diarrhea by drinking lots
of fluids and resuming a typical diet. But for some, especially the young and the old, loss
of body fluids with gastroenteritis can cause dehydration, which is a life-threatening
condition unless it is treated and fluids are replaced.

.
Clinical Manifestations:

• Low grade fever to 100°F (37.8°C)

• Nausea with or without vomiting
• Mild to moderate diarrhea
• Crampy and painful abdominal bloating

More serious symptoms include:

• Blood in vomit or stool

• Vomiting more than 48 hours
• Fever higher than 101°F (40°C)
• Swollen abdomen or abdominal pain
• Dehydration that is manifested by weakness, lightheadedness, decreased and
concentrated urination, dry skin and poor turgor, and dry lips and mouth

Diagnostic Tests:

• Blood test
• Analysis of stool samples
• Electrolyte tests
• Physical examination to rule other existing conditions such as appendicitis

Medical Management:
Home care:

• Clear fluids are appropriate for the first 24 hours to maintain adequate hydration.
 • They should be given oral rehydration solutions such as Pedialyte for pediatric patients
or commercially prepared oral rehydration solution. For homemade ORS, mix 2
tablespoons of sugar (or honey) with ¼ teaspoon of table salt in 1 liter (1 qt) of clean or
previously boiled water.
• After 24 hours without vomiting , begin to offer soft bland foods such as the BRAT diet,
which includes bananas, rice, applesauce without sugar, toast, pasta, and potatoes.

Hospitalization:

• Hydration through intravenous line.

• Replacement of fluid losses volume per volume.
• Encourage small, frequent feedings.

Prevention:

• Always wash your hands before eating and after using the comfort room.
• Eat only properly cooked and stored food.
• Bleach soiled linens used.
• Have vaccinations for salmonella typhi, vibrio cholerae, and rotavirus.
Patients Profile

Client’s Name: G. G

Age: 59 y/o

Birthday: April 24, 1951

Address: San Antonio Valley, Sucat Parañaque City

Civil Status:Single

Sex:Female

Nationality:Filipin o

Religion: Roman Catholic

Informant: Patient

Date of admission: January 17,2011

Chief complaint: Diarrhea

Admitting diagnosis: AGE

Attending physician: Dra. Palogan

History of present illness:

One week prior to admission, patient experienced on and off fever, and took
paracetamol for remedy to her fever.1 day prior to admission pt. had 15 episodes of loose
watery stool and several episodes of vomiting of previously ingested food so she decided to go
to Olivarez General Hospital Emergency Room for prompt treatment. Upon admission her vital
signs were as follows: B.P= 140/100 P.R= 72 RR=24 T= 36.7

Past Medical History:

The patient has hypertension and she was taking anti hypertensive medications to lower
down her blood pressure. She had also an allergy to penicillin and atropine sulfate.
Anatomy and physiology:

Digestion is the process by which food is broken down into smaller pieces so that
the body
can use them to build and nourish cells and to provide energy. Digestion involves the
mixing of food, its movement through the digestive tract (also known as the alimentary
canal), and the chemical breakdown of larger molecules into smaller molecules. Every
piece of food we eat has to be broken down into smaller nutrients that the body can
absorb, which is why it takes hours to fully digest food.

The digestive system is made up of the digestive tract. This consists of a long
tube of organs that runs from the mouth to the anus and includes the esophagus,
stomach, small intestine, and large intestine, together with the liver, gall bladder, and
pancreas, which produce important secretions for digestion that drain into the small
intestine. The digestive tract in an adult is about 30 feet long.

Mouth and Salivary Glands Digestion - begins in the mouth, where chemical and
mechanical digestion occurs. Saliva or spit, produced by the salivary glands (located
under the tongue and near the lower jaw), is released into the mouth. Saliva begins to
break down the food, moistening it and making it easier to swallow. A digestive
enzyme (called amylase) in the saliva begins to break down
the carbohydrates (starches and sugars). One of the most important functions of the
mouth is chewing. Chewing allows food to be mashed into a soft mass that is easier to
swallow and digest later.

Esophagus - Once food is swallowed, it enters the esophagus, a muscular tube that is
about
10 inches long. The esophagus is located between the throat and the stomach.
Muscular wavelike contractions known as peristalsis push the food down through the
esophagus to the stomach. A muscular ring (called the cardiac sphincter) at the end of
the esophagus allows food to enter the stomach, and, then, it squeezes shut to prevent
food and fluid from going back up the esophagus.

Stomach - a J-shaped organ that lies between the esophagus and the small intestine in
the upper abdomen. The stomach has 3 main functions: to store the swallowed food
and liquid; to mix up the food, liquid, and digestive juices produced by the stomach; and
to slowly empty its contents into the small intestine.

Small Intestine - Most digestion and absorption of food occurs in the small intestine. The
small intestine is a narrow, twisting tube that occupies most of the lower abdomen
between the stomach and the beginning of the large intestine. It extends about 20 feet
in length. The small intestine consists of 3 parts: the duodenum (the C-shaped part), the
jejunum (the coiled midsection), and the ileum (the last section). The small intestine has
2 important functions. First, the digestive process is completed here by enzymes and
other substances made by intestinal cells, the pancreas, and the liver. Glands in the
intestine walls secrete enzymes that breakdown starches and sugars. The pancreas
secretes enzymes into the small intestine that help breakdown carbohydrates, fats, and
proteins. The liver produces bile, which is stored in the gall bladder. Bile helps to make
fat molecules (which otherwise are not soluble in water) soluble, so they can be
absorbed by the body. Second, the small intestine absorbs the nutrients from the
digestive process. The inner wall of the small intestine is covered by millions of tiny
fingerlike projections calledvilli. The villi are covered with even tinier projections called
microvilli. The combination of villi and microvilli increase the surface area of the small
intestine greatly, allowing absorption of nutrients to occur. Undigested material travels
next to the large intestine.

Large intestine - forms an upside down U over the coiled small intestine. It begins at the
lower right-hand side of the body and ends on the lower left-hand side. The large
intestine is about 5-6 feet long. It has 3 parts: the cecum, the colon, and the rectum. The
cecum is a pouch at the beginning of the large intestine. This area allows food to pass
from the small intestine to the large intestine. The colon is where fluids and salts are
absorbed and extends from the cecum to the rectum. The last part of the large intestine
is the rectum, which is where feces (waste material) is stored before leaving the body
through the anus. The main job of the large intestine is to remove water and salts
(electrolytes) from the undigested material and to form solid waste that can be excreted.
Bacteria in the large intestine help to break down the undigested materials. The
remaining contents of the large intestine are moved toward the rectum, where feces are
stored until they leave the body through the anus as a bowel movement.
 Case
Analysis
For
 Acute
GastroEnteri
tis
Bruno, Jona D.

BSN IV NCM 104

MR. Delacruz

Physical assessment:

Body parts Techniques Normal Actual Interpretation

assessed findings findings
1. Skin
a. moisture palpation Moisture in Dry skin Deviated due
skin folds and to
axillae dehydration
b. texture palpation Smooth Rough Deviated due
to dehydration
c. turgor Inspection and Recoils back Recoils back Deviated due
 palpation immediately slowly to dehydration
after pinching
skin folds 2- 3
secs.
2. mouth Inspection Pink in color, Dry, cracked Deviated due
a. lips smooth, soft lips to dehydration
moist, no
lesions
b. mucosa Inspection Uniform pink Dry and Deviated due
in color slightly pink in to
color dehydration
c. gums Inspection and Pink gums, Pale gums, Deviated due
palpation moist dry to dehydration
3. abdomen auscultation Normoactive Hyperactive Due to
a. bowel bowel sounds bowel sounds diarrhea
sounds

Pathophysiology:

Non-Non-
modifiable: Modifiable:
modifiable:
Age:Age: (pre-schooler Lifestyle
Secretions Diet
(pre-school children)
Age: (pre-schoolers
of fluids Poor environmental sanitation
and
electrolytes
in the Stimulation and Etiology: E. Salomonela, Shigela,
Person to person Campylobacter jejuni, E. Coli, Contaminated
intestinal DirectIncreased
Digestive
invasionperistaltic
destructionof
and
ofbowel
absorptive
Ingestion of pathogens
mucosal Endotoxins are released
(hands) diarrhea Norovirus, adenovirus food or water
lumen wallmovement
malfunction
lining of bowel wall
 Nausea and
vomiting

G.I distention
Fluids and electrolytes
imbalance

Excessive gas
formation dehydration

Dry lips, dry

mouth, fatigue,
irritability