ACUTE GASTROENTERITIS

INTRODUCTION

Gastroenteritis, often called the "stomach flu," is a common and normally short-lived illness characterized by diarrhea and low-grade fever, cramps, nausea, and vomiting.

INTRODUCTION

On a global scale, gastroenteritis is a massive health problem. About 5 million people die each year, mainly young children in underdeveloped countries. Most deaths are due to dehydration, inadequate fluid replacement and circulatory collapse.

DEFINITION OF TERMSA. GASTROENTERITISGastroenteritis is inflammation of the lining of the stomach and small and large intestines.B. BOBORYGMIRumbling sounds caused by gas moving through the intestines, commonly referred to as stomach "growling".

DEFINITION OF TERMSC. TENESMUSStraining to defecate or urinate.D. DIARRHEADiarrhea describes loose, watery stools that occur more frequently than usual.E. DYSENTERYDysentery is diarrhea which contains blood.

DEFINITION OF TERMSF. VIRUSA virus is a small infectious agent that replicates only inside the living cells of other organisms.G. BACTERIAMicroorganisms comprising one of the three domains of living organisms. They are prokaryotic, unicellular, and either free living in soil or water or parasites of plants or animals.

DEFINITION OF TERMSH. PROTOZOAProtozoa are a diverse group of unicellular eukaryotic organisms, many of which are motile.I. PERISTALSISPeristalsis are a series of muscle contractions that occur in your digestive tract.

DEFINITION OF TERMS

J. SALMONELLA A bacterium that occurs mainly in the intestine, especially a serotype causing food poisoning.

ETIOLOGYVIRUSA. RotavirusIs the most common cause of severe, dehydrating diarrhea among young children. It usually affects those between the ages of 3 months and 15 months. Rotavirus is highly contagious.

ETIOLOGYB. Norovirus Most commonly infects older children and adults. Norovirus infection can cause the sudden onset of severe vomiting and diarrhea. The virus is highly contagious and commonly spread through food or water that is contaminated by fecal matter during preparation

ETIOLOGY

C. Astrovirus Can infect people of all ages but usually infects infants and young children. Infection is most common in the winter and is spread by fecal-oral transmission.

ETIOLOGY

BACTERIAA. Salmonella Salmonellosis is a form of gastroenteritis caused by the germ (bacterium) Salmonella. Salmonellosis can affect anyone. However, most cases occur in children and young adults

ETHIOLOGY

B. Campylobacter Are most frequently acquired from undercooked poultry. Campylobacter is occasionally transmitted by dogs or cats with diarrhea

ETHIOLOGYC. Escherichia Coli Is a Gram-negative, facultatively anaerobic, rod-shaped bacterium of the genus Escherichia that is commonly found in the lower intestine of warm-blooded organisms

ETHIOLOGY

D. Clostridium DifficileAlso known as pseudomembranous colitis is a bacterial dysentery commonly seen in clients who have been receiving large doses of antibiotics.

ETHIOLOGY

PARASITICA. Gardia Stick to or invade the lining of the intestine and cause nausea, vomiting, diarrhea, and a general sick feeling

ETHIOLOGYB. Cryptosporidium Causes watery diarrhea that is sometimes accompanied by abdominal cramps, nausea, and vomiting. The resulting infection, called cryptosporidiosis

TRANSMISSION

1. Fecal-Oral RouteTransmission of infection occurs when infectious particles from feces are ingested through the mouth2. Person-person

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS Diarrhea Nausea Vomiting Anorexia Abdominal Pain Cramping Boborygmi Fever Tenesmus Headache

COMPLICATIONS

1. DEHYDRATIONThis is the most common complication. It occurs if the water and salts that are lost in your stools, or when you vomit, are not replaced by your drinking adequate fluids.

COMPLICATIONSMild Moderate Severe

Weight loss Up to 5% 6-10% More than 10%

Appearance Active, alert Irritable, alert, thirsty Lethargic, looks sick

Capillary filling (compared to your own)

Normal Slightly delayed Delayed

Pulse Normal Fast, low volume Very fast, thready

Respiration Normal Fast Fast and deep

Blood pressure Normal Normal or low Orthostatic hypotension

Very low

COMPLICATIONSMucous memb.

Moist Dry Parched

Tears Present Less than expected

Absent

Eyes Normal Normal Sunken

Pinched skin Springs back Tents briefly Prolonged tenting

Fontanel (infant sitting)

Normal Sunken slightly Sunken significantly

Urine flow Normal Reduced Severely reduced

COMPLICATIONS2. Spread of Infection To other parts of your body such as your bones, joints, or the meninges that surround your brain and spinal cord. This is rare. If it does occur, it is more likely if gastroenteritis is caused by Salmonella spp. infection.

COMPLICATIONS3. Hemolytic uremic syndrome Is another potential complication. It is rare and is usually associated with gastroenteritis caused by a certain type of E. coli infection. It is a serious condition where there is anaemia, a low platelet count in the blood, and kidney failure. It is more common in children. If recognised and treated, most people recover well. The presence of blood or leukocytes in stool is a strong indicator of inflammatory diarrhea.

MEDICAL MANAGEMENT

LABORATORY/DIAGNOSTIC TESTA. Stool cultureThe presence of blood or leukocytes in stool is a strong indicator of inflammatory diarrhea.

MEDICAL MANAGEMENTB. Serum ElectrolytesTo monitor for electrolyte imbalancesHypernatremiaHyperkalemia

MEDICAL MANAGEMENTC. BUNTo evaluate kidney functionD. CreatinineTo assess kidney function

MEDICAL MANAGEMENT

A. Oral and IV RehydrationOral rehydration has been largely responsible for the tremendous decrease in the death rate in underdeveloped countries from infectious diarrhea, including cholera. For pediatric patients, administer 20 mL/kg of isotonic sodium chloride solution initially for resuscitation.

MEDICAL MANAGEMENTOral Rehydration Therapy (ORT) is the process of replacing essential body fluids and salts that a child loses in critical quantities during attacks of diarrhoea. The treatment consists of common salt and sugar mixed in one liter of clean drinking water given to the child by mouth.

NUTRITIONAL MANAGEMENT

It is recommended that breast-fed infants continue to be nursed in the usual fashion, and that formula-fed infants continue their formula immediately after rehydration with ORT.

MEDICAL MANAGEMENT

B. AntiemeticsAntiemetic medications may be helpful for treating vomiting in children. Ondansetron has some utility, with a single dose being associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.

MEDICAL MANAGEMENTC. AntibioticAntibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe.  

MEDICAL MANAGEMENT

 Antimotility agents are contraindicated in the treatment of acute gastroenteritis in children because of their lack of benefit and increased risk of side effects, including ileus, drowsiness, and nausea.

VACCINATION

Rotavirus Vaccine rotavirus vaccine protects children from rotaviruses, which are the leading cause of severe diarrhea among infants and young children. There are two effective rotavirus vaccines: Rotarix and RotaTeq.

PREVENTION Hand Washing Do not eat undercooked foods Thoroughly wash any products before eating

Good sanitation Avoid contaminated food or drink

NURSING MANAGEMENTASSESSMENTCheck temperature, blood pressure, pulse rate and respiratory rate.

Assess for features of dehydrationMeasure weight of the patientCheck capillary refillHistory of food and water intakeAssess for any recent travel to different places

Check for bleeding in the stool

NURSING MANAGEMENT

NURSING DIAGNOSISFluid volume deficit related to excessive gastrointestinal (GI) lossesin stool

Hyperthermia related to dehydrationDeficient fluid volume RT excessive losses through normal routes frequent passage of loose watery stool

Imbalance Nutrition: Less Than Body Requirements

Acute Pain

NURSING MANAGEMENTNURSING INTERVENTIONSMonitor vital signsPerform a thorough abdominal examinationMeasure weight of the patientRegulate accurately IV fluidsMeasure I&OMeasure urine outputEncourage fluid intakeMonitor for signs of bleedingProvide bed restChildren with on going dehydration/on going losses may

need 6 hourly weights to assess hydration status