Role of Family Physician in

management of GE&Dehydration
Dr Asmaa Fathy
Lecturer of Family medicine
 Definition
GASTROENTERITIS =Gastritis+ Enteritis
Gastritis = inflammation of mucosa of
the stomach
Enteritis = inflammation of the Small
intestine
Complain
(Vomiting+Diarrhea)
 Prevalence

During the first 3 years of life

One to three acute severe
episodes
 Causes
Rota virus is the most common viral
infection (50%)
Usually proceeded by upper respiratory tract
infection
Clostridium difficile is the most common
bacterial infection
Giardiasis is the most common protozoal
infection
 Bacterial GE

• High grade fever

• Bad general condition
• Vomiting and sever diarrhea and offensive
stool
• Stool may be bloody
• Common in summer
 Viral GE

• No or low grade fever

• Watery diarrhea
• Yellowish or greenish due to high motion so bile
passes undigested
• Common in winter
 Protozoal GE

• Vomiting usually absent

• Mucus &tenesmus
• Blood tinged
• Long duration >10 days
 Complications of GE

• Dehydration
• Shock
• Renal failure
• Convulsion
• Septicemia
• DIC
 Degree of Dehydration
Symptoms&signs Degree of Dehydration
  NO SOME SEVERE
minimal Moderate
Consciousness Not enough Restless, Lethargic or
signs to irritable unconscious
classify as
Eyes some or Sunken eyes Sunken eyes
Drink &eating severe Drinks Not able to
dehydration eagerly, drink or
thirsty drinking
poorly

Skin pinch Goes back Goes back

slowly very slowly
NB .at least Two or more of the following symptoms and signs must be present
to diagnose a child as having dehydration
 Management of Dehydration

Minimal or no dehydration

Continue usual diet +Drink adequate fluid

 Management of Dehydration

Mild to moderate dehydration

ORS
One packets on 200 cm previously boiled
water give via
Teaspoonful(200 CM=20 teaspoonful)
Or Syringe if failed
via Ryle tube
 Management of Dehydration

Moderate to severe dehydration

IV FLUID
NB probiotic can be used to shorten
the duration of diarrhea
 Return visit

Tell the mother to return immediately if

• There is no improvement within 5 days
• Child becomes sicker
• Not able to drink or breastfeed
• Develop fever
• Blood in stool
 When to refer

• Severe dehydration
• Complications
• High risk baby (preterm ,premature baby,
congenital heart disease, renal problems,
malabsorption
• No improvement within 5 days
 Prevention of GE

Good hand washing

Rota Vaccine
• live attenuated vaccine
• Contraindications (hypersensitivity to
vaccine,GIT congenital
malformaions,immunodeficiency)
• Complications Intussusceptions but rare
 Rota Vaccine

RotaTeq (RV5; Merck) is recommended for routine oral administration for all
infants as a 3-dose series. The usual schedule is at ages 2, 4, and 6 months.
Rotarix (RV1; GlaxoSmithKline) is recommended as a 2-dose series at ages
2 and 4 months.

The minimum interval between doses of rotavirus vaccine is 4 weeks. The

minimum age for the first dose is 6 weeks and the maximum age for dose #1
is 14 weeks 6 days. Vaccination should not be initiated for infants age 15
weeks 0 days or older because there are insufficient data on the safety of
dose #1 in older infants. The maximum age for the last dose of rotavirus
vaccine is 8 months and 0 days.
 Assignment

A mother bring her 18 months old baby

telling you that her child has vomiting and
diarrhea 3days ago on examination the child
appears irritable ,drinks eagrly and has
sunken eyes
Q Describe your management plan
according to degree of dehydration
Q Instructions of return visit