GASTROENTERITIS is the most common bacterial cause of

GASTROENTERITIS

 

Definition:

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–       Inflammation of the lining of the
stomach and intestines, predominantly manifested by upper GI tract symptoms
(anorexia, nausea, vomiting), diarrhea, and abdominal discomfort.

 

Etiology and Epidemiology

 

–      
Gastroenteritis may be of nonspecific, uncertain, or unknown etiology or of bacterial,
viral, parasitic, or toxic etiology

–      
Campylobacter infection is the most common bacterial
cause of diarrheal illness in the USA

–      
Person-to-person
transmission is especially common with gastroenteritis
caused by Shigella, Escherichia coli, Giardia, Norwalk virus, and rotavirus.

 

Pathophysiology

 

–      
Certain bacterial species elaborate enterotoxins, which impair intestinal
absorption and can provoke secretion of electrolytes and water e.g. the enterotoxin
of Vibrio cholerae and E. coli enterotoxin

–      
Some
Shigella, Salmonella, and E. coli species penetrate the mucosa of
the small intestine or colon and produce microscopic ulceration, bleeding,
exudation of protein-rich fluid, and secretion of electrolytes and water.

–       Gastroenteritis may
follow ingestion of chemical toxins
contained in plants (e.g. mushrooms, potatoes, garden flora), seafood (fish,
clams, mussels), or contaminated food.

 

Symptoms and Signs

 

–      
Onset
is often sudden and sometimes dramatic, with anorexia, nausea, vomiting,
borborygmi, abdominal cramps, and diarrhea (with or without blood and mucus).

–      
Associated
malaise, muscular aches, and prostration may occur

–      
If
vomiting causes excessive fluid loss, metabolic alkalosis with hypochloremia
occurs; if diarrhea is more prominent, acidosis is more likely

–      
Excessive
vomiting or diarrhea may cause hypokalemia

–       Severe dehydration and acid-base imbalance can produce
headache and muscular and nervous irritability.

–       Persistent vomiting and diarrhea may result in severe
dehydration and shock, with vascular collapse and oliguric renal failure.

 

Diagnosis

 

–      
A history of ingestion of potentially
contaminated food, untreated surface water, or a known GI irritant; recent
travel; and contact with similarly ill persons may be important.

–      
Stool
examination for fecal WBCs and culture are indicated

–      
Diagnosis
may also require culture of vomitus, food, and blood.

–      
Eosinophilia
may indicate parasitic infection

 

General Principles of Treatment

 

–      
Supportive treatment is most important.

–      
Bed rest with convenient access to a toilet or
bedpan is desirable

–      
When
nausea or vomiting is mild or has ended, oral glucose-electrolyte solutions,
strained broth, or salted bouillon may prevent dehydration or treat mild
dehydration.

–      
Even
if vomiting, the patient should take frequent but small sips of such fluids
because the vomiting may resolve with volume replacement

–      
If
vomiting is protracted or if severe dehydration is prominent, IV replacement of
appropriate electrolytes is necessary

–      
If
vomiting is severe and a surgical condition has been excluded, an antiemetic
(e.g. dimenhydrinate 50 mg IM q 4 h, chlorpromazine >=
25 to 100 mg/day IM) or prochlorperazine 10 mg po tid (suppository 25 mg bid)
may be beneficial.

–      
Meperidine
50 mg IM q 3 or 4 h may be given for severe abdominal cramps.

–      
When
the patient can tolerate fluids without vomiting, bland food (cereal, gelatin,
bananas, and toast) may be added to the diet gradually.

–      
If
after 12 to 24 h, moderate diarrhea persists without severe systemic symptoms
or blood in the stool, diphenoxylate 2.5 to 5 mg tid or qid in tablet or
liquid form, loperamide 2 mg po qid, or bismuth subsalicylate 524 mg (two
tablets or 30 mL) po six to eight times/day may be given.

–      
Antibiotics
appropriate to sensitivity testing should be given when systemic infection is
evident.

–      
However,
antibiotics do not help patients with simple gastroenteritis, nor do they help asymptomatic carriers to
“clear” rapidly.

 

 

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