Gastroenteritis - China CRS-TESTER - CPR-1000 Current Probe Reader Manufacturer - Business

<p>Classification 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 Bacterial gastroenteritis For a list of bacteria causing gastroenteritis see above Pseudomembranous colitis is an important cause of diarrhea in patients often recently treated with antibiotics If gastroenteritis in a child is severe enough to require admission to a hospital then it is important to d
istinguish between bacterial and viral infections Bacteria Shigella and Campylobacter for example and parasites like Giardia can be treated with antibiotics Traveler s diarrhea is usually a type of bacterial gastroenteritis Viral gastroenteritis Viruses causing gastroenteritis include rotavirus norovirus adenovirus and astrovirus Viruses do not respond to antibiotics and infected children usually make a full recovery after a few days 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 These children are routinely tested also for norovirus which is extraordinarily infectious and requires special isolation procedures to avoid transmission to other patients Other methods electron microscopy and polyacrylamide gel electrophoresis are used in research laboratories Symptoms and signs Gastroenteritis often involves stomach pain or spasms diarrhea
and or vomiting with noninflammatory infection of the upper small bowel or inflammatory infections of the colon The condition is usually of acute onset normally lasting 16 days and is self limiting Nausea and vomiting Diarrhea Loss of appetite Fever Headaches Abnormal flatulence Abdominal pain Abdominal cramps Bloody stools dysentery suggesting infection by amoeba Campylobacter Salmonella Shigella or some pathogenic strains of Escherichia coli Fainting and Weakness The main contributing factors include poor feeding in infants Diarrhea is common and may be followed by vomiting Viral diarrhea usually causes frequent watery stools whereas blood stained diarrhea may be indicative of bacterial colitis In some cases even when the stomach is empty bile can be vomited up A child with gastroenteritis may be lethargic suffer lack of sleep run a low fever have signs of dehydration which include dry mucous membranes tachycardia reduced skin turgor skin color discoloration sunken fontan
elles sunken eyeballs darkened eye circles glassy eyes poor perfusion and ultimately shock Diagnosis No specific diagnostic tests are required in most patients with simple gastroenteritis If symptoms including fever bloody stool and diarrhea persist for two weeks or more examination of stool for Clostridium difficile may be advisable along with cultures for bacteria including Salmonella Shigella Campylobacter and Enterotoxic Escherichia coli Microscopy for parasites ova and cysts may also be helpful citation needed Prevention Percentage of rotavirus tests with positive results by surveillance week United States July 2000 June 2009 A rotavirus vaccine has between 2000 and 2009 decreased the number of cases of diarrhea due to rotavirus in the United States Management The objective of treatment is to replace lost fluids and electrolytes Oral rehydration is the preferred treatment of fluid and electrolyte losses caused by diarrhea in children with mild to moderate dehydration Re
hydration The primary treatment of gastroenteritis in both children and adults is rehydration i e replenishment of water and electrolytes lost in the stools This is preferably achieved by giving the person oral rehydration therapy ORT although intravenous delivery may be required if a decreased level of consciousness or an ileus is present Complex carbohydrate based Oral Rehydration Salts ORS such as those made from wheat or rice have been found to be superior to simple sugar based ORS 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 Plain water may be used if specific ORS are unavailable or not palatable Diet 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 Lactose free or lactose reduced formulas usually are not nece
ssary Children receiving semisolid or solid foods should continue to receive their usual diet during episodes of diarrhea Foods high in simple sugars should be avoided because the osmotic load might worsen diarrhea therefore soft drinks juice and other high simple sugar foods should be avoided The practice of withholding food is not recommended and immediate normal feeding is encouraged The BRAT diet bananas rice applesauce toast and tea is no longer recommended as it contains insufficient nutrients and has no benefit over normal feeding Pharmacologic therapy Gastroenteritis is usually an acute and self limited disease that does not require pharmacological therapy Metoclopramide and ondansetron however may be helpful in children Antibiotics Antibiotics are usually not useful for gastroenteritis although they are sometimes used if symptoms are severe or a susceptible bacterial cause is isolated or suspected citation needed If antibiotics are decided on a fluoroquinolone or ma
crolide is often used Pseudomembranous colitis usually caused by antibiotics use is managed by discontinuing the causative agent and treating with either metronidazole or vancomycin Antimotility agents Antimotility drugs have a theoretical risk of causing complications clinical experience however has shown this to be unlikely They are thus discouraged in people with bloody diarrhea or diarrhea complicated by a fever Loperamide an opioid analogue is commonly used for the symptomatic treatment of diarrhea Loperamide is not recommended in children as it may cross the immature blood brain barrier and cause toxicity Bismuth subsalicylate BSS an insoluble complex of trivalent bismuth and salicylate can be used in mild moderate cases Antiemetic drugs Antiemetic drugs may be helpful for vomiting in children Ondansetron has some utility with a single dose associated with less need for intravenous fluids fewer hospitalizations and decreased vomiting Metoclopramide also might be helpfu
l Alternative medications 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 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 A 2009 trial however did not find any benefit from supplementation Complications Dehydration is a common complication of diarrhea It can be made worse with the withholding fluids or the administration of juice soft drinks Malabsorption of lactose the principal sugar in milk may occur Though it may increase the diarrhea however one should not discontinue breastfeeding Epidemiology Disability adjusted life year for diarrhea per 100 000 160 inhabitants 160 160 160 160 160 no data 160 160 160 160 160 50 160 160 160 160 160 50 100 160 160 160 160 160 100 200 160 160 160 160 160 200 300 160 160 160 160 160
300 400 160 160 160 160 160 400 500 160 160 160 160 160 500 750 160 160 160 160 160 750 1000 160 160 160 160 160 1000 1250 160 160 160 160 160 1250 2500 160 160 160 160 160 2500 5000 160 160 160 160 160 5000 Every year worldwide rotavirus in children under 5 causes 111 million cases of gastroenteritis and nearly half a million deaths 82 of these deaths occur in the world s poorest nations In 1980 gastroenteritis from all causes caused 4 6 million deaths in children with most of these occurring in the third world lack of adequate safe water and sewage treatment has contributed to the spread of infectious gastroenteritis 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 The incidence in the developed world is as high as 1 2 5 cases per child per year citation needed and is a major cause of hospitalization in this age group Age living conditions hygie
ne and cultural habits are important factors Aetiological agents vary depending on the climate Furthermore most cases of gastroenteritis are seen during the winter in temperate climates and during summer in the tropics History Before the 20th century the term gastroenteritis was not commonly used What would now be diagnosed as gastroenteritis may have instead been diagnosed more specifically as typhoid fever or cholera morbus among others or less specifically as griping of the guts surfeit flux colic bowel complaint or any one of a number of other archaic names for acute diarrhea Historians genealogists and other researchers should keep in mind that gastroenteritis was not considered a discrete diagnosis until fairly recently U S President Zachary Taylor died of gastroenteritis on July 9 1850 See also Diarrhea 1984 Rajneeshee bioterror attack Food poisoning Eosinophilic gastroenteritis Hemorrhagic gastroenteritis Cholera Dysentery Infectious diarrhea Traveler s diarrhea Wild
erness diarrhea Pseudomembranous colitis Rotavirus Cryptosporidium References a b c d Kasper DL Braunwald E Fauci AS Hauser SL Longo DL Jameson JL Harrison s Principles of Internal Medicine New York McGraw Hill 2005 ISBN 0 07 139140 1 King CK Glass R Bresee JS Duggan C November 2003 Managing acute gastroenteritis among children oral rehydration maintenance and nutritional therapy MMWR Recomm Rep 52 RR 16 116 PMID 14627948 160 Norovirus Technical Fact Sheet National Center for Infectious Diseases CDC http www cdc gov ncidod dvrd revb gastro norovirus factsheet htm 160 a b Murray PR Pfaller MA Rosenthal KS Medical Microbiology Mosby 2005 ISBN 0323033032 Seven Surfing Sicknesses a b c d e The Oxford Textbook of Medicine Edited by David A Warrell Timothy M Cox and John D Firth with Edward J Benz Fourth Edition 2003 Oxford University Press ISBN 0 19 262922 0 Haffejee IE 1991 The pathophysiology clinical features and management of rotavirus diarrhoea Q J Med 79 288 28999 PMID 1649
479 160 Patel MM Tate JE Selvarangan R et al 2007 Routine laboratory testing data for surveillance of rotavirus hospitalizations to evaluate the impact of vaccination Subscription required Pediatr Infect Dis J 26 10 9149 doi 10 1097 INF 0b013e31812e52fd PMID 17901797 160 Pediatric ROTavirus European CommitTee PROTECT 2006 The paediatric burden of rotavirus disease in Europe Epidemiol Infect 134 5 90816 doi 10 1017 S0950268806006091 PMID 16650331 160 Beards GM 1988 Laboratory diagnosis of viral gastroenteritis Eur J Clin Microbiol Infect Dis 7 1 113 doi 10 1007 BF01962164 PMID 3132369 160 Steel HM Garnham S Beards GM Brown DW 1992 Investigation of an outbreak of rotavirus infection in geriatric patients by serotyping and polyacrylamide gel electrophoresis PAGE J Med Virol 37 2 1326 doi 10 1002 jmv 1890370211 PMID 1321223 160 a b c d e f Sleisenger amp Fordtran s Gastrointestinal and Liver Disease 7th edition by Mark Feldman Lawrence S Friedman and Marvin H Sleisenger ISBN 0 7
216 8973 6 Hardback Saunders Published July 2002 a b c d Mandell s Principles and Practices of Infection Diseases 6th Edition 2004 by Gerald L Mandell MD MACP John E Bennett MD Raphael Dolin MD ISBN 0 443 06643 4 Hardback 4016 Pages Churchill Livingstone www cdc gov http www cdc gov mmwr preview mmwrhtml mm5841a2 htm 160 Practice parameter the management of acute gastroenteritis in young children American Academy of Pediatrics Provisional Committee on Quality Improvement Subcommittee on Acute Gastroenteritis Pediatrics 97 3 42435 1996 PMID 8604285 160 BestBets Fluid Treatment of Gastroenteritis in Adults http www bestbets org bets bet php id 1039 160 Canavan A Arant BS October 2009 Diagnosis and management of dehydration in children Am Fam Physician 80 7 6926 PMID 19817339 160 Gregorio GV Gonzales ML Dans LF Martinez EG 2009 Polymer based oral rehydration solution for treating acute watery diarrhoea Cochrane Database Syst Rev 2 CD006519 doi 10 1002 14651858 CD006519 pub2 PMI
D 19370638 160 a b c Diarrhoea and vomiting in children under 5 http www nice org uk Guidance CG84 summary 160 a b Managing Acute Gastroenteritis Among Children Oral Rehydration Maintenance and Nutritional Therapy http www cdc gov mmwR preview mmwrhtml rr5216a1 htm 160 BestBets Gradual introduction of feeding is no better than immediate normal feeding in children with gastro enteritis http www bestbets org bets bet php id 390 Retrieved December 6 2008 160 a b King CK Glass R Bresee JS Duggan C November 2003 Managing acute gastroenteritis among children oral rehydration maintenance and nutritional therapy MMWR Recomm Rep 52 RR 16 116 PMID 14627948 http www cdc gov mmwr preview mmwrhtml rr5216a1 htm 160 Alhashimi D Al Hashimi H Fedorowicz Z 2009 Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents Cochrane Database Syst Rev 2 CD005506 doi 10 1002 14651858 CD005506 pub4 PMID 19370620 160 DeCamp LR Byerley JS Doshi N Steiner MJ September
2008 Use of antiemetic agents in acute gastroenteritis a systematic review and meta analysis Arch Pediatr Adolesc Med 162 9 85865 doi 10 1001 archpedi 162
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