Ways to prevent Gastroenteritis

General(caused by bacteria):

· Wash hands thoroughly with soap and water after going to the toilet or changing nappies, after smoking, after using a handkerchief or tissue, or after handling animals.

· Wash your hands thoroughly with soap and water before preparing food or eating.

· Use disposable paper towels to dry your hands rather than cloth towels, since the bacteria can survive for some time on objects.

· Keep cold food cold (below 5°C) and hot foot hot (above 60°C) to discourage the growth of bacteria.

· Make sure foods are thoroughly cooked.

· Clean the toilet and bathroom regularly, especially the toilet seat, door handles and taps.

· Clean baby change tables regularly.

· When traveling overseas to countries where sanitation is suspect, only drink bottled water. Brush your teeth in bottled water too. Avoid food buffets, uncooked foods or peeled fruits and vegetables.

Gastroenteritis caused by virus

· There are still no ways to prevent gastroenteritis caused by virus.

Gastroenteritis caused by emotional upsets:

· Make conscious efforts to reduce stress in life.

§ Balance the demand of works and school works with opportunities for leisure time with friends and family.



by tin yee

Mechanism of Compensation for Dehydration

The Mechanisms In Fluid Balance

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) Aldosterone

d) Sympathetic nervous system - system that is responsible for fight of flight response

Action of ADH.

ADH (Antidiuretic Hormone, Arginine vasopressin; AVP; Vasopressin)
- produced in the hypothalamus and released at the posterior pituitary gland
- causes reabsorption of H2O at the distal tubule of the nephron

· losing water causes increased solute concentration in the plasma

· osmoreceptors detect the increased concentration of solutes in the interstitial fluid, which reflects the increase osmolarity in the plasma

· ADH is released into the plasma at the posterior pituitary

· ADH acts on the distal convulated tube and the collecting duct. It promotes the addition of water channels and therefore increases the permeability of the DCT and CD to water.

· More water reabsorbed into the plasma, less urine produced. Plasma osmolarity decreases again

Thirst Mechanism.

· Primary regulator of water intake and involves hormonal and neural input as well as voluntary behavior.

· Plasma osmotic pressure (plasma osmolarity) increases stimulating the osmoreceptors in the thirst centre of the hypothalamus .

· Decrease blood volume and pressure causes release of rennin and the production of angiotensin II which stimulates the thirst centre.

· Salivation is reduced as the mouth and throat feel dry. A sense of thirst is formed.


The Renin-Angiotensin-Aldosterone system.

· When someone suffers from hypovolemia, there is blood volume lost as well as a drop in blood pressure.

· Decrease in pressure in the afferent arteriole is sensed by the baroreceptors which leads to the stimulation of the release of renin from the juxtaglomerular cells of the afferent arteriole.

· Renin converts a protein into angiotensin (I) as an Angiotensin-converting-enzyme (ACE) converts angiotensin(I) to angiotensin (II).

· Angiotensin II reduces urine production by two ways:

a) It leads to vasoconstriction of the afferent and efferent arterioles increasing renal vascular resistance and reducing renal blood flow. This causes a decrease in the glomerular capillary hydrostatic pressure and the glomerular filtration rate (GFR). Reduction of GFR will result to reduction in urine production.

b) Secondary role in volume regulation by stimulating the synthesis of aldosterone from the adrenal gland.

Aldosterone in turn leads to increase of pemearbility of the DCT and CD to Na+and Cl-. More Na+and Cl- absorbed into the blood plasma which eventually followed by the flow of water into the blood plasma. Hence volume of urine is reduced.

Sympathetic Nervous System.

· Volume depletion will lead to decreased blood volume and venous return to the heart.

· This is then sensed by the baroreceptors (volume receptors) at the atria and pulmonary veins and pressure receptors at the renal afferent arteriole which will lead to the sympathetic activity.

· This will result in sympathetically mediated vasoconstriction. (sim

Differential Diagnosis for Gastroenteritis

 by Xin Wei

Pneumonia:

Inflammatory illness in the lungs

Symptoms : 

nausea, vomiting, loss of appetite, joint pains, unusually rapid breathing, chest pains, muscle aches, high fever with  shaking chills , cough producing yellow sputum.

 

Cough is usually not present in GE.

 

Appendicitis

What it is:

Painful swelling and inflammation of the appendix

 

Symptoms:

The abdominal pain usually

• occurs suddenly, often causing a person to wake up at night
• occurs before other symptoms
• begins near the belly button and then moves lower and to the right
• is new and unlike any pain felt before
• gets worse in a matter of hours
• gets worse when moving around, taking deep breaths, coughing, or sneezing

Other symptoms of appendicitis may include

• loss of appetite
• nausea
• vomiting
• constipation or diarrhea
• inability to pass gas
• a low-grade fever that follows other symptoms
• abdominal swelling
• the feeling that passing stool will relieve discomfort

 

Investigation

·  Rebound tenderness.

applying hand pressure to a patient’s abdomen and then letting go.

Pain felt upon the release of the pressure indicates rebound tenderness.

·  Rovsing’s sign.

Applyi hand pressure to the lower left side of the abdomen.

Pain felt on the lower right side of the abdomen upon the release of pressure on the left side

 

Pain in GE is generalised and tenderness is not well localised.

Absence of these signs rules out Appendicitis.

 

Bowel Obstruction

What it is:

mechanical or functional obstruction of the intestines, preventing the normal transit of theproducts of digestion

 

Symptoms:

abdominal pain, vomiting, constipation

 

GE is not associated with constipation.

Therefore, bowel obstruction is ruled out.

 

Ulcerative Colitis

What it is

Causes inflammation and sores, called ulcers, in the lining of the rectum and colon.

Ulcers form where inflammation has killed the cells that usually line the colon,

then bleed and produce pus.

Inflammation in the colon also causes the colon to empty frequently, causing diarrhea.

 

Symptoms:

Abdominal pain

Bloody diarrhoea

 anaemia

 fatigue

weight loss

loss of appetite

rectal bleeding

loss of body fluids and nutrients

skin lesions

joint pain

growth failure (specifically in children)

 

 

Usually not associated with vomiting.

Therefore ruled out.

If diarrhoea persists, colonoscopy is done. 

Predisposing Factors of Gastroenteritis :

1) Nutritional status
>Breast-fed infants are better nourished than formula-fed infants
~ Breast-fed infants have stronger immunity.

2) Water quality
>Unboiled water, drink water directly from tap water.
~ Microorganisms in tap water are not killed if the water is consumed directly from the tap water.

3) Feeding Practices
> Cutlery used to feed the children – whether they are clean or dirty

> Contamination of food :
~ Uncovered food
~ Consume food which drops on the floor

> Sharing of food – the bacteria can be transmitted though saliva

4) Personal hygiene
> Never wash hands before eating .

>Putting fingers into the mouth eg. after having fun in the playground or playing with dirt.

5) Environment factors
> Dirty environment

>Poor house sanitation which attracts house flies, cockroaches, mouse etc.

Causes of Gastroenteritis

Gastroenteritis is caused by an infection of the stomach and intestine. The infection is caused mainly by bacteria, viruses and parasites which interfere with one of the main functions of the intestines that is in the absorption of water and its distribution around the body.

• No absorption of water
  
• Water is still in the tract
• Body has to get rid of water
• Diarrhea(down the tract)/ vomiting(up the tract)

Types of viruses that cause viral gastroenteritis

Viruses that cause gastroenteritis are Norovirus, Rotavirus, Adenovirus and Astrovirus. The most common among all are Norovirus and Rotavirus. But we will talk more about Norovirus.

Norovirus

· Occurs at any time of the year

· In addition to diarrhea , nausea, vomiting a person may experience muscle aches, headaches, fatigue and low grade fever

· Common within environments such as hospitals, nursing homes, schools

· Illness can spread easily from person to person and the virus can survive for several days in a contaminated area

· Ways of getting infected: a) contact with surface or object that are contaminated with the virus

b) by eating or drinking contaminated food or water

c) contact with an infected person

There are many different types of norovirus and it is possible for the infection to occur several times. This is because after getting the illness, immunity to the virus only lasts for 14 days.

Other causes of Gastroenteritis

1. Food Poisoning

· Can be caused by bacteria (Salmonella, E. Coli) or virus

· Mostly it is caused by bacteria which can lead to gastroenteritis

· Food can be contaminated in several ways:

a) Meat is not cooked properly

b) Food is not properly stored and refrigerated eg: meat, eggs, dairy products

c) Food is washed in dirty water

d) Food is handled by someone with a bacterial infection who has not washed their hands after going to the toilet (indirect contact)

2. Contaminated Water

· Animal or human faeces in water can lead to gastroenteritis

· In developed countries it is less likely to happen

· In non well developed countries such as Africa and South Asia it is more likely as there isn’t good water purification equipment available

3. Antibiotics

· Certain antibiotics can kill off the so called ‘friendly bacteria’(useful bacteria) that live in the stomach and the intestines

· Therefore we are more likely to get infected by other types of bacteria that can cause gastroenteritis

· Gastroenteritis caused by taking antibiotic is known as ‘antibiotic-associated gastroenteritis”

· “antibiotic associated gastroenteritis” is usually mild and symptoms should pass within a few days

4. Travellers diarrhea

· Parasites such as Giardia lamblia and Cryptosporidium can cause diarrhea

· Get contracted when travelling in a foreign country

· Common in countries with low standards of public hygiene

· Can be caused by consuming contaminated food or water

· Most cases are usually mild and pass within a few days

SIGNS and SYMPTOMS

Signs & Symptomsby Viran

· Nausea - Nausea is that queasy feeling of unease with which everyone is familar. It often occurs with or precedes vomiting, but both nausea-without-vomiting and vomiting-without-nausea are possible. Nausea is the body's way of reacting to an infection or condition. Any nausea or vomiting symptom needs prompt professional medical investigation.

· Vomiting - Vomiting is emitting stomach contents from the mouth. This is not the same as regurgitation, which refers to emitting already swallowed food, and must be distinguished correctly

· Diarrhea - Chronic diarrhea refers in medical terms to repeated bouts of diarrhea over a prolonged period.

· Generalized abdominal pain and cramps.

· Mild Fever

· Weakness

· Dehydration

· Tiredness

· Audible rumbling of intestines

---

Majid ,,

Gastroenteritis Signs And Symptoms:

Main Symptoms:

- Watery diarrhea

- Vomiting [even when the stomach is empty, bile can be vomited up]

Other Symptoms:

- Dehydration, Dry mucus membrane

^ Since body looses a large amount of fluids

- Headache

- Fever

- Abdominal cramps "stomach ache"

- Nausea

- Loss of Appetite

- Fainting and weakness

- Bloody Stools

- Lethargic

- Lack of sleep

- Tachycardia "increased heart-rate"

- Ultimately Shock

Signs:

- Reduced skin rigidity

^ What gives a cell its rigidity is the water inside it. When there is no enough

water, rigidity of cells decrease.

- Sunken fontanelles

- Sunken eyeballs

- Darkened eye circles

- Glassy eyes

- Poor perfusion

- Skin color discoloration

Investigation [Laboratory tests]:

- 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

Signs to differentiate between GE and Appendicitis:

Rectal Tenderness:

- GE: usually absent

- App. : usually present

Painful ride to the hospital:

- GE: usually absent

- App. : usually present

Diarrhea:

- GE: profuse "high-volume", increased peristalsis, low pitch.

- App. : low volume, decreased peristalsis, high pitch

Peri-umbilical pain:

- GE: with or after vomit

- App. : before vomit

Terms:

Fontanelles: soft spots on a baby's head which, during birth, enable the bony plates of the skull to flex, allowing the child's head to pass through the birth canal.

ELISA: Enzyme-Linked ImmunoSorbent Assay. A biochemical technique used to detect the presence of an antibody or an antigen.

Peristalsis: involuntary constriction and relaxation of the muscles of the intestine creating a wavelike movements to push the intestine contents forward.

by majid

What is GE??

What Is Gastroenteritis?

Gastroenteritis refers to the inflammation of the stomach and intestines by some infectious agent. Most gastroenteritis is caused by a viral infection but sometimes bacteria may cause it also. For example, toxins in food. Gastroenteritis has been a leading cause of death among infants and children under 5. The most common problem with gastroenteritis is dehydration. These fluids are lost mainly through vomiting and diarrhea. Hence, replacement of the lost fluids is essential to maintain the fluid balance of the body.

Most of the cases of gastroenteritis as foodborne illnesss are caused by norovirus. Norovirus is an RNA virus which can cause gastroenteritis. It can affect people of all ages. Norovirus are normally found in the stool or vomit of infected people and people can be infected by coming in direct contact with it. Currently, there is no available treatment for norovirus but it can be prevented by frequent washing of hands and avoiding contaminated objects.

Majority of the severe gastroenteritis cases in children are due to rotavirus. Rotavirus infection is common within kids aged 5 and below. It is one of the most common causes of diarrhea. Diarrhea caused by rotavirus is responsible for more than half a million deaths worldwide each year, especially in developing countries where nutrition and health care are not optimal. Rotavirus is present in child care centers and children hospitals which is a huge problem because it is extremely contagious. Kids can become infected by touching a contaminated object and putting their hands into their mouths. Thankfully, there is a vaccine for rotavirus. It is highly recommended for all infants to be immune to this virus.

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