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.
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.
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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