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ACUTE GASTROENTERITIS

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 hasnothing to do with the condition.

Travelers to foreign countries may experience "traveler's diarrhea" from contaminated food

and unclean water.

y The severity of infectious gastroenteritis depends on the immune system's ability to resist the

infection. Electrolytes (these include essential elements ofsodium and potassium) may be lost

as you vomit and experience diarrhea.

y 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 causedehydration, which is a life-threatening illness

unless the condition is treated and fluids restored.

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

thenoroviruses.Rotavirus is the leading cause of infection in children.Other viruses that cause

gastrointestinal symptoms include:

y Adenoviruses

y Parvoviruses

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y Astroviruses

Bacteria

Bacteria may cause gastroenteritis directly by infecting the walls of the stomach and

intestine.A

s well, some bacteria like Staphylococcus aureus can form a toxin that is the cause of symptoms. Staph is a common type of food poisoning.

y Salmonella - the cause of typhoid fever is contracted from handling poultry or reptiles such as

turtles that carry the germs

y Campylobacter - from the consumption of undercooked meat, unpasteurized milk

y 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.

Symptoms

By definition, gastroenteritis affects both the stomach and the intestines, resulting in both

vomiting and diarrhea.

Common symptoms may include:

y Low grade fever to 100°F (37.7°C)

y Nausea with or without vomiting

y Mild-to-moderate diarrhea:

y Crampy painful abdominal bloating

More serious symptoms

y Blood in vomit or stool

y Vomiting more than 48 hours

y Fever higher than 101°F (40°C)

y Swollen abdomen or abdominal pain

y Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry mouthand lack of sweat and tears are characteristic findings.

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Medical Treatment

U pon 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 toconsider trying oral rehydration therapy. Frequent feedings, as small as a 1/6 ounce (5cc) at atime, may be used to restore hydration.

Medications

Doctors usually don't prescribe antibiotics until bacteria have been identified. Antibiotics may begiven for certain bacteria, specificallyCampylobacter, Shigella, and Vibrio cholerae, if properly

identified through laboratory testing. Otherwise, using any antibiotic or the wrong antibiotic canworsen some infections or make them last longer.

Some infections, like salmonella, are not treated with antibiotics. With supportive care of fluidsand rest, the body is able to resolve the infection without antibiotics.

For adults, the doctor may give medications to stop vomiting (antiemetics) such

aspromethazine (Phenergan, Anergan),prochlorperazine (Compazine), or ondansetron(Zofran).Sometimes these medications are prescribed as a suppository. Doctors usually do not recommend

antiemetics for infants. Children who are a little older may be offered antiemetic medication.

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-countermedications 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.

y Always wash your hands.

y Eat properly prepared and stored food.

y Bleach soiled laundry.

y Vaccinations for Salmonella typhi, Vibrio cholerae, and rotavirus have beendeveloped. 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.

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