Gastroenteritis

From Wikipedia, the free encyclopedia

Gastroenteritis
Classification and external resources

Gastroenteritis viruses: A = rotavirus, B = adenovirus, C = Norovirus and D = Astrovirus. The virus particles are shown at the same magnification to allow size comparison.

ICD-10

A02.0, A08., A09.,J10.8, J11.8, K52.

ICD-9

009.0, 009.1, 558

DiseasesDB

30726

eMedicine

emerg/213

MeSH

D005759

Gastroenteritis (also known as gastric flu, stomach flu, and stomach virus, although unrelated to influenza) is marked by severe inflammation of thegastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water. The inflammation is caused most often[citation needed] by an infection from certain viruses or less often[citation needed] bybacteria, their toxins (e.g. SEB), parasites, or an adverse reaction to something in the diet or medication. At least 50% of cases of gastroenteritis resulting from foodborne illness are caused by norovirus.[1] Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus[2] and astrovirus.

Risk factors include consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation. It is also common for river swimmers to become infected during times of rain as a result of contaminated runoff water.[3]

Contents
[hide]

1 Symptoms and signs 2 Cause

2.1 Bacterial 2.2 Viral

3 Diagnosis

3.1 Differenti al

4 Prevention

4.1 Lifestyle 4.2 Vaccinati on

5 Management

5.1 Rehydrati on

5.2 Diet 5.3 Medicatio ns

5.4 Alternativ e medicine

6 Complications 7 Epidemiology 8 History 9 References 10 External links

[edit]Symptoms

and signs

Gastroenteritis often involves stomach pain or spasms, diarrhea and/or vomiting, with noninflammatory infection of the upper small bowel, or inflammatory infections of the colon.[4][5][6][7] The condition is usually of acute onset, normally lasting 16 days, and is self-limiting.

Nausea and vomiting Diarrhea Dehydration Fever Abnormal flatulence Abdominal cramps Bloody stools (dysentery suggesting infection by amoeba, Campylobacter, Salmonella, Shigella or some pathogenic strains of Escherichia coli[2])

Heartburn

The main contributing factors include poor feeding in infants. Diarrhea is common, and may be followed by vomiting. Viral diarrhea usually causes frequent watery stools, whereas blood stained diarrhea may be indicative of bacterial colitis. In some cases, even when the stomach is empty, bile can be vomited up. A child with mild or moderate dehydration may have a prolonged capillary refill, poor skin turgor and abnormal breathing.[8]

[edit]Cause [edit]Bacterial
Different species of pathogenic bacteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus,Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, Vibrio cholerae, and others. Some sources of the infection are improperly prepared food, reheated meat dishes, seafood, dairy, and bakery products. Each organism causes slightly different symptoms but all result in diarrhea. Colitis, inflammation of the large intestine, may also be present. Such pathogenic enteric bacteria are generally distinguished from the usually harmless bacteria of the normal gut flora, but the distinction is often not fully clear, and Escherichia, for example, can belong to either group. Pseudomembranous colitis is an important cause of diarrhea in patients often recently treated with broad-spectrum antibiotics.Traveler's diarrhea is usually a type of bacterial gastroenteritis. If gastroenteritis in a child is severe enough to require admission to a hospital, then it is important to distinguish between bacterial and viral infections. Bacteria like, Shigella and Campylobacter, andparasites like Giardia can be treated withantibiotics.

[edit]Viral

Viruses causing gastroenteritis include rotavirus, norovirus, adenovirus and astrovirus. Viruses do not respond to antibiotics and infected children usually make a full recovery after a few days.[9] Children admitted to hospital with gastroenteritis routinely are tested for rotavirus A to gather surveillance data relevant to the epidemiological effects of rotavirus vaccination programs.[10]
[11]

These children are routinely tested also for norovirus, which is extraordinarily infectious and requires special isolation procedures

to avoid transmission to other patients. Other methods, electron microscopy andpolyacrylamide gel electrophoresis, are used in research laboratories.[12][13]

[edit]Diagnosis
Gastroenteritis is diagnosed based on symptoms, a complete medical history and a physical examination. An accurate medical history may provide valuable information on the existence or inexistence of similar symptoms in other members of the patient's family or friends. The duration, frequency, and description of the patient's bowel movements and if they experience vomiting are also relevant and these question are usually asked by a physician during the examination. [14] As hypoglycemia may occur in 9% of children measuring serum glucose is recommended.[8] No specific diagnostic tests are required in most patients with simple gastroenteritis. If symptoms including fever, bloody stool and diarrhea persist for two weeks or more, examination of stool forClostridium difficile may be advisable along with cultures for bacteria including Salmonella, Shigella, Campylobacter and enterotoxic Escherichia coli. Microscopy for parasites, ova and cysts may also be helpful.[citation needed] A complete medical history may be helpful in diagnosing gastroenteritis. A complete and accurate medical history of the patient includes information on travel history, exposure to poisons or otherirritants, diet change, food preparation habits or storage and medications. Patients who travel may be exposed to E. Coli infections or parasite infections contacted from beverages or food. Swimming in contaminated water or drinking from suspicious fresh water such as mountain streams or wells may indicate infection from Giardia - an organism found in water that causes diarrhea. Food poisoning must be considered in cases when the patient was exposed to undercooked or improperly stored food. Depending on the type of bacteria that is causing the condition, the reactions appear in 2 to 72 hours. Detecting the specific infectious agent is required in order to establish a proper diagnosis and an effective treatment plan. The doctor may want to find whether the patient has been using broad-spectrum or multiple antibiotics in their recent past. If so, they could be the cause of an irritation of the gastrointestinal tract. During the physical examination, the doctor will look for other possible causes of the infection. Conditions such as appendicitis, gallbladder disease, pancreatitis or diverticulitis may cause similar symptoms but a physical examination will reveal a specific tenderness in the abdomen which is not present in gastroenteritis. Diagnosing gastroenteritis is mainly an exclusion procedure. Therefore in rare cases when the symptoms are not enough to diagnose gastroenteritis, several tests may be performed in order to rule out other gastrointestinal disorders. These include rectal examinations, complete blood count, electrolytes and kidney function tests. However, when the symptoms are conclusive, no tests apart from the stool tests are required to correctly diagnose gastroenteritis especially if the patient has traveled to at-risk areas.

[edit]Differential
Infectious gastroenteritis is caused by a wide variety of bacteria and viruses. It is important to consider infectious gastroenteritis as adiagnosis per exclusionem. A few loose stools and vomiting may be the result of systemic infection such as pneumonia,septicemia, urinary tract infection and meningitis. Surgical conditions such as appendicitis, intussusception and, rarely, Hirschsprung's diseaseshould be in the differential. Endocrine disorders (e.g.thyrotoxicosis and Addison's disease) are disorders that can cause diarrhea. Also, pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should be excluded as possibilities.[5]

[edit]Prevention

Percentage of rotavirus tests with positive results, by surveillance week, United States, July 2000--June 2009.

[edit]Lifestyle
Good hand washing has been found to decrease the rates of gastroenteritis in both the developing and developed world by about 30%.[8] Alcohol based gels may also be effective.[8] Avoidance of potentially contaminated food or drink may useful as a preventative measure.[15]

[edit]Vaccination
Since 2000, the implementation of a rotavirus vaccine has decreased the number of cases of diarrhea due to rotavirus in the United States.[16] It may be given to infants aged 6 to 32 weeks.[17] The vaccines has side effects that are similar to the mild flu symptoms. Different types of vaccinations are available for Salmonella typhi and Vibrio cholera and which may be administered to people who intend traveling in at-risk areas. However, the vaccines that are currently available are effective only on rotavirual gastroenteritis.

[edit]Management
Gastroenteritis is usually an acute and self-limited disease that does not require pharmacological therapy.[18] The objective of treatment is to replace lost fluids and electrolytes. Oral rehydration is the preferred method of replacing these losses in children with mild to moderate dehydration.[19] Metoclopramide and ondansetron however may be helpful in children.[20]

[edit]Rehydration
The primary treatment of gastroenteritis in both children and adults is rehydration, i.e., replenishment of water and electrolytes lost in the stools. This is preferably achieved by giving the person oral rehydration therapy (ORT) although intravenous delivery may be

required if a decreased level of consciousness or an ileus is present.[21][22] Complex-carbohydrate-based oral rehydration therapy such as those made from wheat or rice may be superior to simple sugar-based ORS.[23] Sugary drinks such as soft drinks and fruit juice are not recommended for gastroenteritis in children under 5 years of age as they may make the diarrhea worse.
[18]

Plain water may be used if specific ORS are unavailable or not palatable.[18] Intravenous fluids are recommended if severe

dehydration is present, there is a decreased level of consciousness, or there is hemodynamic compromise (typically low blood pressure or a fast heart rate).[8]

[edit]Diet
It is recommended that breastfed infants continue to be nursed on demand and that formula-fed infants should continue their usual formula immediately after rehydration with oral rehydration solutions. Lactose-free or lactose-reduced formulas usually are not necessary.[24] Children receiving semisolid or solid foods should continue to receive their usual diet during episodes of diarrhea. Foods high insimple sugars should be avoided because the osmotic load might worsen diarrhea; therefore substantial amounts of soft drinks, juice, and other high simple sugar foods should be avoided.[24] The practice of withholding food is not recommended and immediate normal feeding is encouraged.[25] The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.[26]

[edit]Medications
Antiemetics Antiemetic drugs may be helpful for vomiting in children. Ondansetron has some utility with a single dose associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.[27][28][20] Metoclopramide also might be helpful.[20] However there was an increased number of children who returned and were subsequently admitted in those treated with ondansetron.[29]The intravenous preparation of ondansetron may be given orally.[30] Antibiotics Antibiotics are not usually used for gastroenteritis, although they are sometimes used if symptoms are severe (such as dysentery)
[31]

or a susceptible bacterial cause is isolated or suspected.[32] If antibiotics are decided on, a fluoroquinolone or macrolide is often

used.[6] Pseudomembranous colitis, usually caused by antibiotics use, is managed by discontinuing the causative agent and treating with either metronidazole or vancomycin.[6][7] Antimotility agents Antimotility drugs have a theoretical risk of causing complications; clinical experience, however, has shown this to be unlikely.[5]
[6]

They are thus discouraged in people with bloody diarrhea or diarrhea complicated by a fever.[4] Loperamide, an opioid analogue,

is commonly used for the symptomatic treatment of diarrhea.[6] Loperamide is not recommended in children as it may cross the immature blood brain barrier and cause toxicity. Bismuth subsalicylate (BSS), an insoluble complex of trivalent bismuth and salicylate, can be used in mild-moderate cases.[5][6] Antispasmotics

Butylscopolamine (Buscopan) is useful in treating crampy abdominal pain.[33]

[edit]Alternative
Probiotics

medicine

Some probiotics have been shown to be beneficial in preventing and treating various forms of gastroenteritis.[26] They reduce both the duration of illness and the frequency of stools.[34] Fermented milk products (such as yogurt) also reduce the duration of symptoms.[35] Zinc The World Health Organization recommends that infants and children receive a dietary supplement of zinc for up to two weeks after onset of gastroenteritis.[36] A 2009 trial however did not find any benefit from supplementation.[37]

[edit]Complications
Dehydration is a common complication of diarrhea. It can be made worse with the withholding fluids or the administration of juice / soft drinks.[38] Reactive arthritis also called Reiter's syndrome can follow infectious dysentery. Onset typically occurs one to three weeks following the infection and may present acutely or insidiously.

[edit]Epidemiology

Disability-adjusted life year for diarrhea per 100,000 inhabitants in 2004.

no data less 500 500-1000 1000-1500 1500-2000 2000-2500 2500-3000 3000-3500 3500-4000 4000-4500 4500-5000 5000-6000 6000

Every year, worldwide, rotavirus in children under 5 causes 111 million cases of gastroenteritis and nearly half a million deaths. 82% of these deaths occur in the world's poorest nations.[39] In 1980 gastroenteritis from all causes caused 4.6 million deaths in children with most of these occurring in the third world.[7] Lack of adequate safe water andsewage treatment has contributed to the spread of infectious gastroenteritis. Current death rates have come down significantly to approximately 1.5 million deaths annually in the year 2000, largely due to the global introduction of oral rehydration therapy.[40]

The incidence in the developed world is as high as 1-2.5 cases per child per year[citation needed] and is a major cause of hospitalization in this age group. Age, living conditions, hygiene and cultural habits are important factors. Aetiological agents vary depending on the climate. Furthermore, most cases of gastroenteritis are seen during the winter in temperate climates and during summer in the tropics.[7]

[edit]History
Before the 20th century, the term "gastroenteritis" was not commonly used. What would now be diagnosed as gastroenteritis may have instead been diagnosed more specifically as typhoid fever or "cholera morbus", among others, or less specifically as "griping of the guts", "surfeit", "flux", "colic", "bowel complaint", or any one of a number of other archaic names for acute diarrhea.
[41]

Historians, genealogists, and other researchers should keep in mind that gastroenteritis was not considered a discrete diagnosis

until fairly recently. U.S. President Zachary Taylor died of "cholera morbus", equivalent to a diagnosis of gastroenteritis, on July 9, 1850.[42]

http://en.wikipedia.org/wiki/Gastroenteritis

Gastroenteritis Causes
Gastroenteritis has many causes. Viruses and bacteria are the most common. Viruses and bacteria are very contagious and can spread through contaminated food or water. In up to 50% of diarrheal outbreaks, no specific agent is found. The infection can spread from person to person because of improper handwashing following a bowel movement or handling a soiled diaper. Gastroenteritis caused by viruses may last one to two days. However, some bacterial cases can continue for a longer period of time.

Viruses
Norovirus - Fifty to seventy percent of cases of gastroenteritis in adults are caused by thenoroviruses (genus Norovirus, familyCaliciviridae. This virus is highly contagious and spreads rapidly. Norovirus is the most common cause of gastroenteritis in the United States.

Noroviruses can be transmitted and infect individuals by contaminated food and liquids, touching objects contaminated with norovirus and then placing the hands or fingers in the mouth, direct contact with an infected individual (for example, exposure to norovirus when caring or sharing foods, drinks, eating utensils with an affected individual, and exposure to infected individuals and objects in daycare centers and nursing homes. Norovirus is often in the news when cruise ship passengers contract the virus, which causes gastroenteritis.

Rotavirus - According to the CDC, "Rotavirus was also the leading cause of severe diarrhea in U.S. infants and young children before rotavirus vaccine was introduced for U.S. infants in 2006. Prior to that, almost all children in the United States were infected with rotavirus before their 5th birthday. Each year in the United States in the pre-vaccine period, rotavirus was responsible for more than 400,000 doctor visits; more than 200,000 emergency room visits; 55,000 to 70,000 hospitalizations; and 20 to 60 deaths in children younger than 5 years of age." Other viruses that cause gastrointestinal symptoms include:

Adenoviruses - This virus most commonly causes respiratory illness; however, other illnesses may be caused by adenoviruses such as gastroenteritis, bladder infections, and rash illnesses. Parvoviruses - The human bocavirus (HBoV), which can cause gastroenteritis belongs to the family Parvoviridae. Astroviruses - Astrovirus infection is the third most frequent cause of gastroenteritis in infants.

Bacteria
Bacteria may cause gastroenteritis directly by infecting the lining of the stomach and intestine. Some bacteria such as Staphylococcus aureus produce a toxin that is the cause of the symptoms. Staph is a common type of food poisoning. Escherichia coli infection can cause significant complications. E. coli O157:H7(one type of the bacteria) can cause complications in approximately 10% of affected individuals (for example, kidney failure in children [hemolytic-uremic syndrome or HUS), bloody diarrhea, and thrombotic thrombocytopenic purpura (TTP) in the elderly. Salmonella, Shigella and Campylobacter Salmonella, Shigella and Campylobacter are also common causes of illness.

Salmonella is contracted by ingesting the bacteria in contaminated food or water, and by handling poultry or reptiles such as turtles that carry the germs. Campylobacter occurs by the consumption of raw or undercooked poultry meat and crosscontamination of other foods. Infants may contract the infection by contact with poultry packages in shopping carts. Campylobacter is also associated with unpasteurized milk or contaminated water. The infection can be spread to humans by contact with infected stool of an ill pet (for example, cats or dogs). It is generally not passed from human to human. Shigella bacteria generally spreads from an infected person to another person.Shigella are in diarrheal stools of infected individuals while they are ill, and for up to one to two weeks after contracting the infection. Shigella infection also may be contracted from eating contaminated food, drinking contaminated water, or swimming or playing in contaminated water (for example, wading pools, shallow play fountains). Shigella can also be spread among men who have sex with men. Clostridium difficile

Clostridium difficile (C difficile) bacteria may overgrow in the large intestine after a person has been on antibiotics for an infection. The most common antibiotics that pose a potential risk factor for C difficile include

clindamycin (for example, Cleocin), fluoroquinolones (for example, levofloxacin [Levaquin'], ciprofloxacin [Cipro, Cirpo XR, Proquin XR]), penicillins, and cephalosporins. Other risk factors for C difficile infection are hospitalization, individuals 65 years of age or greater, and existing chronic medical conditions.

Parasites and Protozoans

These tiny organisms are less frequently responsible for intestinal irritation. A person may become infected by one of these by drinking contaminated water. Swimming pools are common places to come in contact with these parasites. Common parasites include

Giardia is the most frequent cause of waterborne diarrhea, causing giardiasis. Often, people become infected after swallowing water that has been contaminated by animal feces (poop). This may occur by drinking infected water from river or lakes but giardia may also be found in swimming pools, wells and cisterns. Cryptosporidium (Crypto) is a parasite that lives in the intestine of affected individuals or animals. The infected individual or animal sheds theCryptosporidium parasite in the stool. Crypto may also be found in food, water, soil, or contaminated surfaces (swallowing contaminated recreational water, beverages, uncooked food, unwashed fruits and vegetables, touching contaminated surfaces such as bathroom fixtures, toys, diaper pails, changing tables, changing diapers, caring for an infected individual or handling an infected cow or calf). Those at risk for serious disease are individuals with weakened immune systems.

Other Common Causes of Gastroenteritis

Gastroenteritis that is not contagious to others can be caused by chemical toxins, most often found in seafood, food allergies, heavy metals, antibiotics, and other medications.

http://www.emedicinehealth.com/gastroenteritis/page2_em.htm

pathophysiology of acute gastroenteritis

Tiny , 14:42 , Default , Comments(0) , Trackbacks(0) , Reads(4958) , Via Original Large | Medium | Small

Gastroenteritis - Wikipedia, the free encyclopedia Etiology and Pathophysiology . common cause of gastroenteritis in the US. . These toxins generally cause acute nausea, vomiting, and diarrhea within 12 h of .->

MCHPediatric Gastroenteritis . Gastroenteritis (Acute Diarrhea)- Discuss incidence, pathophysiology, clinical . Pathophysiology: Viral pathogens cause acute gastroenteritis by tissue invasion .->

pathophysiology of acute gastroenteritis? Background: Gastroenteritis is a nonspecific term for various pathologic states of . Pathophysiology: Infectious agents usually cause acute gastroenteritis. .->

WikiAnswers - What is the pathophysiology of acute gastroenteritis Health question: What is the pathophysiology of acute gastroenteritis? . Pathophysiology of Acute gastroenteitis? Pathphysiology of Acute gastroenteritis? .->

WikiAnswers - How does a pathophysiology of acute gastroenteritis look like

Health question: How does a pathophysiology of acute gastroenteritis look like? . of gastroenteritis? Acute gastritis pathophysiology? How acute .->

What is Acute Gastroenteritis? Brief and Straightforward Guide: What is Acute Gastroenteritis? . pathophysiology of acute gastroenteritis? - anon3495. What is the pathophysiology of acute .->

Dr. Guandalini's Slides on Acute Diarrhea and Oral Rehydration

Pathophysiology. Pathophysiology. Clinical features. Clinical features . Evidence-based Guidelines for the Management of Acute Gastroenteritis in Children in .->

Gastroenteritis Gastroenteritis. Acute gastroenteritis is defined as diarrheal . Most episodes of acute gastroenteritis will resolve within 3 to 7 days. Pathophysiology .->

gastroenteritis: Definition from Answers.com The pathophysiology, clinical features and management of rotavirus . "Practice parameter: the management of acute gastroenteritis in young children. .->