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Diarrhoea,causes, signs snd symptoms, pathophysiology and treatment options

GASTROENTERITIS

Definition

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.

Content created and supplied by: Pauline123 (via Opera News )

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