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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.