Gastroenteritis
WebMD;
Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract). Diarrhea, crampy abdominal pain, nausea, and vomiting are the most common symptoms.
Viral infection is the most common cause of gastroenteritis but bacteria, parasites, and food-borne illness (such as shellfish) can be the offending agent.
Many people who experience the vomiting and diarrhea that develop from these types of infections or irritations think they have food poisoning, and they may indeed have a food-borne illness. Many people also refer to gastroenteritis as stomach flu, although influenza has nothing to do with the condition.
The severity of infectious
gastroenteritis depends on the immune systems ability to resist the infection. Electrolytes (these include essential
elements of
sodium and potassium) may be lost as you vomit and
experience
diarrhea.
Travelers to foreign countries may experience travelers diarrhea from contaminated food and unclean water.
The severity of infectious gastroenteritis depends on the immune systems ability to resist the infection. Electrolytes (these include essential elements of sodium and potassium) may be lost as you vomit and experience diarrhea.
Most people recover easily from a short bout with vomiting and diarrhea by drinking fluids and easing back into a normal diet. But for others, such as infants and the elderly, loss of bodily fluid with gastroenteritis can cause dehydration, which is a life-threatening illness unless the condition is treated and fluids restored.
Gastroenteritis causes
Gastroenteritis has many causes. Viruses and bacteria are the most common.
Viruses and bacteria are very contagious and can spread through contaminated food or water. In up to 50% of diarrheal outbreaks, no specific agent is found. Improper handwashing following a bowel movement or handling a diaper can spread the disease from person to person.
Gastroenteritis caused by viruses may last one to two days. On the other hand, bacterial cases can last for a longer period of time.
Viruses
Fifty to seventy percent of cases of gastroenteritis in adults are caused by the noroviruses.
Rotavirus is the leading cause of infection in children.
Other viruses that cause gastrointestinal symptoms include:
Adenoviruses
Parvoviruses
Astroviruses
Bacteria
Bacteria may cause gastroenteritis directly by infecting the walls of the stomach and intestine. As well, some bacteria like Staphylococcus aureus can form a toxin that is the cause of symptoms. Staph is a common type of food poisoning.
Escherichia coli can cause significant problems, and one type of the bacteria, E. coli O157:H7 can also affect kidney function.
Salmonella, Shigella and Campylobacter
Salmonella, Shigella and Campylobacter are also common causes of illness.
Salmonella - the cause of typhoid fever is contracted from handling poultry or reptiles such as turtles that carry the germs
Campylobacter - from the consumption of undercooked meat, unpasteurized milk
Shigella - typically spread from person to person
Clostridium difficile
Clostridium difficile (C difficile) bacteria may overgrow in the large intestine after a patient has been on antibiotics for an infection.
Parasites and protozoans
These tiny organisms are less frequently responsible for intestinal irritation. You may become infected by one of these by drinking contaminated water. Swimming pools are common places to come in contact with these parasites. Common parasites include these:
Giardia - The most frequent cause of waterborne diarrhea, causing giardiasis
Cryptosporidium - Affects mostly people with weakened immune systems and causes watery diarrhea
Other common causes
Gastroenteritis that is not contagious to others can be caused by chemical toxins, most often found in seafood, food allergies, heavy metals, antibiotics, and other medications.
Gastroenteritis symptoms
By definition, gastroenteritis affects both the stomach and the intestines, resulting in both vomiting and diarrhea.
Common symptoms may include:
Low grade fever to 100F (37.7C)
Nausea with or without vomiting
Mild-to-moderate diarrhea:
Crampy painful abdominal bloating
More serious symptoms
Blood in vomit or stool
Vomiting more than 48 hours
Fever higher than 101F (40C)
Swollen abdomen or abdominal pain
Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry mouth and lack of sweat and tears are characteristic findings.
Exams and tests
Gastroenteritis is often self-limiting, and the care is supportive to control symptoms and prevent dehydration. Tests may not be needed.
If the symptoms persist for a prolonged period of time, the physician may want to consider blood and stool tests to determine the cause of the vomiting and diarrhea.
As always, taking a thorough history is of great value, as is the physical examination.
The patient will be asked if other family or friends have similar exposure or symptoms. The doctor will want to know about the duration, frequency, and description of the patients bowel movements and whether they are vomiting. The patient will be asked how often and the amount they are urinating to help the doctor determine if fluid loss is causing dehydration. Has the patient lost any weight?
The doctor also will take a medical history, including the following:
Travel history: Travel may suggest E. colibacterial infection or a parasite infection from something the patient ate or drank.
Exposure to poisons or other irritants:Swimming in contaminated water or drinking from suspicious fresh water such as mountain streams or wells may indicate infection from Giardia - an organism found in water that causes diarrhea.
Diet change, food preparation habits, and storage: When the disease occurs following exposure to undercooked or improperly stored or prepared food such as potato salad at a picnic, food poisoning must be considered. In general, symptoms caused by bacteria or their toxins will become
apparent after the following amount of time:
Staphylococcus aureus in 2-6 hours
Clostridium 8-10 hours
Salmonella in 12-72 hours
Other noninfectious gastrointestinal diseases like Crohns disease or ulcerative colitis must also be considered. The doctor also will feel the abdomen for masses.
A rectal examination may be considered, in which the physician inspects the anus for any abnormalities and then inserts a finger in to the rectum to feel for masses. Stool obtained during this test may be tested for the presence of blood.
The doctor may perform other lab tests, including a complete blood count, electrolytes, and kidney function tests. Stool samples may be tested for blood and different types of infection,
Gastroenteritis treatment
Dehydration in children
For dehydration in children, they should be given oral rehydration solutions such as Pedialyte, Rehydrate, Resol, and Rice-Lyte. They contain a good balance of electrolytes that allow better absorption in the stomach than water alone. As well, rehydration with plain water can affect the sodium concentration in the body and lead to seizures.
Dehydration in adults
Although adults and adolescents have a larger electrolyte reserve than children, electrolyte imbalance and dehydration may still occur as fluid is lost through vomiting and diarrhea. Severe symptoms and dehydration usually develop as complications of medication use or chronic diseases such as diabetes or kidney failure, however, symptoms may occur in healthy people.
Clear fluids are appropriate for the first 24 hours to maintain adequate hydration.
After 24 hours of fluid diet without vomiting, begin a soft-bland solid diet such as the BRAT diet.
Medical treatment
Upon seeking medical attention, if the patient cannot take fluids by mouth because of vomiting, the doctor may insert an IV to put fluid back into the body (rehydration).
In infants, depending upon the level of dehydration, intravenous fluids may be delayed to consider trying oral rehydration therapy. Frequent feedings, as small as a 1/6 ounce (5cc) at a time, may be used to restore hydration.
Medications
Doctors usually dont prescribe antibiotics until bacteria have been identified. Antibiotics may be given for certain bacteria, specificallyCampylobacter, Shigella, and Vibrio cholerae, if properly identified through laboratory testing. Otherwise, using any antibiotic or the wrong antibiotic can worsen some infections or make them last longer.
Doctors generally avoid antidiarrheal medications for all age groups if they suspect the infection is caused by a toxin. The most common antidiarrheal agents for people older than three years are over-the-counter medications such as diphenoxylate atropine (Lomotil, Lofene, Lonox) or loperamide hydrochloride (Imodium).
Prevention
With most infections, the key is to block the spread of the organism.
Always wash your hands.
Eat properly prepared and stored food.
Bleach soiled laundry.
Vaccinations for Salmonella typhi, Vibrio cholerae, and rotavirus have been developed. Rotavirus vaccination is recommended for infants in the U.S. Vaccines for S. typhi and V. cholerae may be administered to individuals traveling in at-risk areas.
Compiled by: Dr. Rafiqul Islam
emedicinehealth
