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GASTROENTERITIS

FACULTY OF MEDICINE
UNIVERSITY OF NORTH SUMATERA
HAJI ADAM MALIK GENERAL HOSPITAL
MEDAN
2013
Introduction
.
Common stomach and bowel infection that is usually
associated with vomiting and diarrhea
Most cases are due to viral infections. About a half are
caused by the rotavirus
On global scale
5 million people die each year, mainly young children in
underdeveloped countries
Most deaths are due to dehydration
In Australia
An occasional fatality still occurs with gastroenteritis, again mainly
due to complications of severe dehydration
Definition
.
Gastroenteritis
An infection or inflammation of the
digestive tract, particularly the stomach
and intestines
Usually associated with vomiting and
diarrhea. Sometimes a fever will also be
present. In more severe cases, signs of
dehydration may appear.

Etiology
.
Bacteria
Can caused inflammation diarrhea and non-inflammation
Inflammation : campylobacter jejuni, salmonella, etc
Non- inflammation : E.coli Enteropatogen
Parasite
Giardia lamblia most common causes.
Virus
Viruses are found in human feces. Infection is caused by person-
to-person contact such as touching contaminated hands, feces or
vomit, or by drinking contaminated water or food.
Rotavirus, adenovirus enterik, astovirus dan kalsivirus
Pathophysiology
.
Direct invasion of
the bowel wall
Endotoxin are
admhgfdsa
Secretion of F&E in
the intestinal
lumen
Increase peristaltic
movement
Attempted
defecation
(tenesmus)
Digestive and
absorptive
malfunction
Stimulation and destruction
of mucosal lining of the
bowel wall
Excessive gas
formation
Ingestion of fecally
contaminated food &
water
Predisposing factors
Age
Malnutrition
Precipitating factors
Contaminated food and
water
Gi distention
Death
Untreated.

Hypovolemic shock
Serious fluid volume
deficit
Intense diarrhea
(>10x) (watery stool)
LI is overhelmed &
unable to reabsorb
the lost fluid
Increase protein in the
lumen
Fluids & electrolytes
imbalance

Mild diarrhea

Nausea & Vomiting
Clinical Manifestations
.
Duration
Frequency & amount
of stools
The time since last
episode of diarrhea
Quality of stools
Diarrhea
Duration
Amount and quality of
vomitus
The time since last
episode of vomiting
Vomiting
Increase or decrease in
frequency
Time since last
urination
Colour and
concentration of urine
urination
Location
Quality
Severity
Timing of pain
Abdomial
pain
Presence of
fever,chills,
myalgias.
Rash,sore throat
Sign of
infection
Weight loss
Quality of feeding
Level of alertness
lethargy
Appearance
and behavior
Diagnosis
.


The symptoms of gastroenteritis are usually
enough to identify the illness
It is important to establish the cause, as
different types of gastroenteritis respond to
different treatments.
Diagnosis methods may include :
Medical history
Physical examination
Blood tests
Stool tests
Treatment
.
First, assess your patient
for dehydration

A

B

c
1. Look at
Condition
Eyes
Tears
Mouth &
tounge
Thirst


Well, alert
normal
present
moist

drinks normally, not
thirsty



Restless, irritable
Sunken
Absent
Dry

Thirsty , drinks
eagerly
lethargic or unconscious :
floppy
very sunken and dry
Absent
Very dry

Drinks poorly or not able
to drink
.
2. Feel
Skin pinch

Goes back
quickly

Goes back slowly

Goes back very
slowly
3. Decide The patient has no
sign of dehidration
If the patient has
two or more signs
including at least
one *sign*, there is
some
DEHYDRATION
If the patient has
two or more signs,
including at least
one *sign*, there is
SEVERE
DEHYDRATION
4. Treat Use treatment plan
A
Weigh the patient,
if possible, and use
treatment plan B
Weigh the patient
and use treatment
plan C urgently
Plan A
Explain the 3 rules for
treating diarrhea at
home

1. Give the child more
fluids than usual to
prevent dehydration
2. Give the child plenty of
food to prevent
malnutrition

3. Take the child to the
health worker if the
child does not get
better in 3 days or
develops any of the
following :
Many watery stools
Repeated vomiting
Marked thirst
Eating or drinking
poorly
Fever
Blood in stool

PLAN B
Approximately amount of ORS solution to give
in the first 4 hours :

Age
Less than 4
months
4-11
months
12-23
months
2-4 years 5-14 years 15 years or
older

Weight


< 5kg

5-7.9kg

8kg-10.9kg


11-15.9 kg

16-29.9kg

>30kg

In Ml


200-400

400-600

600-800

800-1200

1200-2200

2200-2400

In local
measure
.
Observe the child carefully and
help the mother give ORS
solution
After 4 hours, reassess the child
using the assessment chart. Then
select plan A,B or C to continue
treatment
PLAN C
To treat severe dehydration quickly
Can you give
intravenous (IV)
immediately ?
Start IV fluid immediately. If the patient can drink, give ORS
by mouth while the drip is set up. Give 100ml/kg Ringers
lactate Solution (or if not available, normal saline), divided as
follows :







Reassesment the patient every 12 hours. If hydration is not
improving, give the IV drip more rapidly
Give ORS abuout 5ml/kbb/hour as soon as the patient can
drink
After 6 hours, evaluate the patient using assessmern chart


Age 1
st
give 30ml/kg
in :
Then give 70
ml/kg in :
Infants (under
12 months)
I hour 5 hours
older 30 minutes 2 hours
Is IV treatment
available nearby?
(within 30 mins?)
Send the patient immediately for IV treatment
If the patien can drink, provide the mother with ORS
solution and show her to give it during the trip
Is IV treatment
available nearby?
(within 30 mins?)
Are you trained to
use a naso-gastric
tube for
rehydration?
Start rehydration by tube with ORS solution. Give
20ml/kg/hour for 6 hours (total of 120ml/kg)
Reassess the patient every 1-2 hours
After 6 hours, reassess again.
Can the patient
drink?
Start rehydration by tube with ORS solution. Give
20ml/kg/hour for 6 hours (total of 120ml/kg)
Reassess the patient every 1-2 hours
After 6 hours, reassess again.
URGENT : Send the
patient for IV or NG
treatment
Prognosis
Gastroenteritis is usually resolved within 2 to 3
days and there are no long-term effects. If
dehydration occurs, recovery is extended by a
few days.