Summary of GE

Gastroenteritis is inflammation of the intestines by an infectious agent.

The predisposing factors are:
1) Nutritional status
2) Water quality
3) Food sanitary and sharing of food
4) Personal hygiene and environmental factors.

Causes:
1) Viruses (norovirus, rotavirus, adenovirus, astrovirus)
- Contact with contaminated object/surface
- Consuming contaminated food/water
- Contact with infected person

2) Bacteria (salmonella)
- Food not cooked properly
- Food washed in dirty water
- food not properly stored
- food handled by infected person

Symptoms
1) Nausea
2) Lethargy
3) Vomiting
4) Diarrhea

Signs to look out for:
1) Reduced skin rigidity
2) Sunken fontanels
3) Sunken eyeballs
4) Poor perfusion linking to pale skin

Differential diagnosis
1) Appendicitis
- Radiating pain from right side. Pain in GE is generalized and tenderness is not localized.
- Rebound tenderness.
- Rovsing’s sign.

2) Bowel obstruction
- GE is not associated with constipation.

3) Ulcerative Colitis
- GE is associated with vomiting where as this is not.

4) Pneumonia
- Cough is usually not present in GE.

Investigations
- Examination of stool for toxins
- Stool cultures for the organisms that cause the disease
- Microscopy for parasites and their ova and cysts.
- ELISA for virus

Fluid balance
- Disruption caused by excessive loss of water and reduced intake.
- Loss is caused by vomiting and diarrhea whereas intake is reduced due to lethargy.
- This leads to hypovolemia.

Body compensation
a) ADH
b) Thirst mechanism
- When there is a deficit of water with decreased volume and increased osmolarity , the thirst center in the hypothalamus is stimulated which prompts the individual to ingest fluid
c) Renin-Angiotensin-Aldosterone System
d) Sympathetic nervous system - system that is responsible for fight of flight response

Management
1) ORS (Oral rehydration salts)
- quickly replaces water and electrolyte loss. Should be taken in small frequent sips.
2) Fluids to take
- rehydration drinks or diluted fruit juices are okay.
3) Food should not be withheld but there should be no force feeding as well.
4) In case of severe dehydration, intravenous therapy is introduced.
5) Make sure infected person does not handle/share any food/towels
6) Regularly clean the infected person’s toilet
7) Stay home until free from vomiting/diarrhea for 48 hours.
8) Additional meals daily for 2 weeks to make up for nutritional loss.

Prevention
1) Wash hands frequently
2) Wash hands before preparing food/eating
3) Use disposable towels, not cloth as it can incubate the bacteria
4) Make sure food is thoroughly cooked.
5) Clean toilet regularly
6) In places with lack of sanitary, only drink bottled water