Gastroenteritis Overview

Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract). The most common symptoms are diarrhea, crampy abdominal pain, nausea, and

vomiting. Many people also refer to gastroenteritis as "stomach flu." This can sometimes be confusing because influenza (flu) symptoms include headache, muscle aches and pains, and respiratory symptoms, but influenza does not involve the gastrointestinal tract. The term stomach flu presumes a viral infection, even though there may be other causes of infection. Viral infections are the most common cause of gastroenteritis but bacteria, parasites, and food-borne illnesses (such as shellfish) can also be the offending agents. Many people who experience vomiting and diarrhea that develops from these types of infections or irritations think they have "food poisoning," when they actually may have a food-borne illness. Travelers to foreign countries may experience "traveler's diarrhea" from contaminated food and unclean water. The severity of infectious gastroenteritis depends on the immune system's ability to resist the infection. Electrolytes (these include essential elements of sodium and potassium) may be lost as the affected individual vomits and experiences diarrhea. Most people recover easily from a short episode of vomiting and diarrhea by drinking fluids and gradually progressing to a normal diet. But for others, such as infants and the elderly, loss of bodily fluid with gastroenteritis can causedehydration, which is a life-threatening illness unless the condition is treated and fluids restored.

Gastroenteritis Symptoms
By definition, gastroenteritis affects both the stomach and the intestines, resulting in both vomiting and diarrhea. Common gastroenteritis symptoms Low grade fever to 100 F (37.7 C) Nausea with or without vomiting

Mild-to-moderate diarrhea Crampy painful abdominal bloating (The cramps may come in cycles, increasing in severity until a loose bowel movement occurs and the pain resolves somewhat.) More serious symptoms of gastroenteritis

Blood in vomit or stool (Blood in vomit or stool is never normal and the affected individual should call or a visit a health care practitioner.) Vomiting more than 48 hours Fever higher than 101 F (40 C) Swollen abdomen or abdominal pain Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry mouth and lack of sweat and tears are characteristic signs and symptoms.

Symptoms of gastroenteritis include:

o o o o o o o Nausea Vomiting Indigestion Fever Chills Diarrhea: Blood in the stool Stool may contain mucus or pus Stool incontinence Excessive gas Fatigue Muscle aches Abdominal pain: Lower abdominal pain Upper abdominal pain Often described as cramping abdominal pain Abdominal tenderness Lower abdominal tenderness Upper abdominal tenderness Anorexia

Additional symptoms of gastroenteritis in infants include:

Infant feeding problems Fussy infant

Loss of fluids from diarrhea may cause dehydration. Symptoms of dehydration due to gastroenteritis may include: o Decreased urination: No urination for over 8 hours Dizziness Faintness Dry mouth Dry skin Fainting Nausea Excessive thirst Weakness or fatigue Rapid pulse Unintentional weight loss Lethargy Convulsions

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 o contaminated food and liquids,

o o

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.

Gastroenteritis Treatment
Gastroenteritis Self-Care and Home Remedies
The treatment of gastroenteritis is aimed at hydration and home remedies that address keeping fluid in the body are key to recovery. Since most causes of gastroenteritis are due to viruses, replacing the fluid lost because of vomiting and diarrhea allows the body to recuperate and fight the infection. Dehydration can also intensify the symptoms of nausea and vomiting. The critical step is replacing fluids when the affected individual is nauseous and doesn't want to drink (hydrate). This is especially difficult with infants and children. Small frequent offerings of clear fluids, sometimes only a mouthful at a time, may be enough to replenish the body's fluid stores and prevent an admission to the hospital for intravenous (IV) fluid administration. In general, clear fluids (anything you can see through), may be tolerated in small amounts. Think of it as adding just an ounce or less to the saliva that the patient is already swallowing. However, giving too much fluid at one time may cause increased nausea due to a distended stomach, which causes additional irritation. Clear fluids do not include carbonated beverages but colas or ginger ale with the fizz gone is often well tolerated. Coke syrup may also be helpful in settling the stomach. Jello and popsicles may be "solid food" alternatives to clear fluids in children who aren't interested in clear fluids. Dehydration in children Oral rehydration therapy using balanced electrolyte solutions such as Pedialyte or Gatorade/Powerade may be all that is needed to replenish the fluid supply in an infant or child. Plain water is not recommended because it can dilute the electrolytes in the body and cause complications such as seizures due to low sodium. The key to oral rehydration is small frequent feedings. If offered free access to a bottle, infants especially may drink quickly to quench their thirst and then vomit. Instead it may be best to limit the amount of fluid given at one time. There are a variety of regimens that are used and they follow a basic format: Offer 1/3 of an ounce (5 to 10 cc) of fluid at one time. Wait 5 to 10 minutes then repeat. If this amount is tolerated without vomiting, increase the amount of fluid to 2/3 of an ounce (10 to 20 cc). Wait and repeat. If tolerated, increase the fluid offered to 1 ounce (30 cc) at a time. If vomiting occurs, go back to the 1/3 of an ounce (5 to 10 cc) and restart. Once the child is tolerating significant fluids by mouth, a more solid diet can be offered.

The important thing to remember is that the goal is to provide fluid to the child and not necessarily calories. In the short term, hydration is more important than nutrition. For infants and children, fluid status can be monitored by whether they are urinating, if they have saliva in their mouths, tears in their eyes, and sweat in their armpits or groin. If the child's baseline weight is known, dehydration can be measured by comparing weight. Medical care should be accessed immediately, if the child is listless, floppy or does not seem to be acting like they normally do. Dehydration in adults Although adults and adolescents have a larger electrolyte reserve than children, electrolyte imbalance and dehydration may still occur as fluid is lost through vomiting and diarrhea. Severe symptoms and dehydration usually develop as complications of medication use or chronic diseases such as diabetes or kidney failure; however, symptoms may occur in healthy people. Clear fluids are appropriate for the first 24 hours to maintain adequate hydration. After 24 hours of fluid diet without vomiting, begin a soft-bland solid diet such as the BRAT diet (bananas, rice, apples, toast) and then progress the diet to other foods as tolerated. Treatment for most forms of viral gastroenteritis is largely supportive as antibiotics provide no benefit. General treatment includes clear liquid diet, hydration, and fever control. Bacterial gastroenteritis treatment varies based on the species of bacteria. Some may benefit from intravenous fluids and antibiotics. Treatment for gastroenteritis includes: o o o o o o Oral rehydration therapy for older children and adults: Drink clear liquids only, such as water, sports drinks (best), fruit juice and dilute tea. Drink small quantities of fluids frequently, such as 2 tablespoons of fluid every 5 minutes. The absence of food allows the intestines to rest. May be able to advance to full liquid diet once symptoms improve Effective to treat mild to moderate dehydration Avoid milk and dairy products Intravenous fluids for severe dehydration Medications for nausea and vomiting:

o o o o o o o o o o

Metoclopramide (Reglan) Ondansetron (Zofran) Prochlorperazine (Compazine, Compro) Medications to control diarrhea: Loperamide (Imodium) Diphenoxylate and Atropine (Lomotil) Antibiotics for bacterial gastroenteritis Ciprofloxacin (Cipro) Cefixime (Suprax) Sulfamethoxazole and Trimethoprim (Bactrim, Septra, TMP-SMX) Rifaximin (Xifaxan, RedActiv, Flonorm) Erythromycin (E.E.S., E-Mycin, Eryc, Ery-Tab)

Gastroenteritis Diagnosis
Gastroenteritis is often self-limiting, and the care is supportive to control symptoms and prevent dehydration. Tests may not be needed. If the symptoms persist for a prolonged period of time, the health care practitioner may consider blood and stool tests to determine the cause of the vomiting and diarrhea.

Patient History and Physical Examination

Taking a thorough patient history and physical examination is very helpful in accessing the diagnosis. Questions asked by the health care practitioner may ask include 1. Have any other family members or friends had had similar exposure or symptoms? 2. What is the duration, frequency, and description of the patient's bowel movements, and is vomiting present? 3. Can the patient is tolerate any fluids by mouth? These questions help determine the potential risk of dehydration and may also include asking questions about the amount and frequency of urination, weight loss, lightheadedness, andfainting (syncope). Other information in the medical history that may be helpful in the diagnosis of gastroenteritis include: Travel history: Travel may suggest E. coli bacterial infection or a parasite infection from something the patient ate or drank. Norovirus infections tend to occur when many people are confined to a close space (for example, cruise ship).

Exposure to poisons or other irritants: Swimming in contaminated water or drinking from suspicious fresh water such as mountain streams or wells may indicate infection with Giardia - an organism found in water that causes diarrhea. Diet change, food preparation habits, and storage: When the disease occurs following exposure to undercooked or improperly stored or prepared food (for example foods at picnics and BBQs that should be refrigerated to avoid contamination), food poisoning must be considered. In general, symptoms caused by bacteria or their toxins will become apparent after the following amount of time: o o o Staphylococcus aureus in 2 to 6 hours Clostridium 8 to 10 hours Salmonella in 12 to 72 hours Medications: If the patient has used antibiotics recently, they may have antibiotic-associated irritation of the gastrointestinal tract, caused byclostridium difficile infection. Physical examination will explore the reasons for symptoms that may not be related to infection. If there are specific tender areas in the abdomen, the health care practitioner may want to determine if the patient has appendicitis, gallbladder disease, pancreatitis, diverticulitis, or other conditions that may be the cause of the patient's symptoms. Other noninfectious gastrointestinal diseases such as Crohn's disease, ulcerative colitis, or microscopic colitis also must be considered. The health care practitioner will feel the abdomen for masses. A rectal examination may be considered, in which the physician inspects the anus for any abnormalities and then inserts a finger in the rectum to feel for any masses. Stool obtained during this test may be tested for the presence of blood. The health care practitioner may perform other laboratory tests, including complete blood count (CBC), electrolytes, and kidney function tests. Stool samples may collected and tested for blood or different types of infection.

Gastroenteritis Medical Treatment

Upon seeking medical attention, if the patient cannot take fluids by mouth because of vomiting, the health care practitioner may insert an IV replace fluid back into the body (rehydration). In infants, depending upon the level of dehydration, intravenous fluids may be delayed to consider trying oral rehydration therapy. Frequent feedings, as small as a 1/6 ounce (5 cc) at a time, may be used to restore hydration.

Pictures of Gastroenteritis Infections

Media file 1: Cryptococcus colitis (shown at the arrows). Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University.

Media type: Photo Media file 2: Pathological changes seen in intestinal lumen with pseudomembranous colitis (indicated by arrows). Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University.

Media type: Photo Media file 3: Strongyloides stercoralis parasite (highlighted by arrows). Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University.

Media type: Photo Media file 4: Giardia lamblia (indicated by the arrows). Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University.

Media type: Photo Media file 5: Normal stain of stool sample looking for ova, parasites, andleukocytes. Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University.

Gastroenteritis Prevention
With most infections, the key is to block the spread of the organism. Always wash your hands. Eat properly prepared and stored food. Bleach soiled laundry. Vaccinations for Vibrio cholerae, androtavirus have been developed. Rotavirus vaccination is recommended for infants in the U.S.. Vaccines for V. cholerae may be administered to individuals traveling in at-risk areas.

When to Seek Medical Care

Most often gastroenteritis is self-limiting, but it can cause significant problems with dehydration. Should that be a concern, contacting a primary care provider is reasonable. Vomiting blood or having bloody or black bowel movements are not normal, and emergency care should be sought. Some medications such as iron or bismuth subsalicylate (Pepto-Bismol) can turn stool black in color. Fever, increasing severity of abdominal pain, and persistent symptoms should not be ignored and seeking medical care should be considered.

Gastroenteritis Medications
Antibiotics are usually not prescribed until a bacteria or parasite has been identified as the cause of the infection. Antibiotics may be given for certain bacteria, specifically Campylobacter,Shigella, and Vibrio cholerae, if properly identified through laboratory tests. Otherwise, using any antibiotic or the wrong antibiotic can worsen some infections or make them last longer. Antibiotics are not used to treat virus infections. Some infections, such as salmonella, are not treated with antibiotics. With supportive care of fluids and rest, the body is able to fight and resolve the infection without antibiotics. For adults, the health care practitioner may prescribe medications to stop the vomiting (antiemetics) such as promethazine(Phenergan, Anergan), prochlorperazine(Compazine), or ondansetron (Zofran). Sometimes these medications are prescribed as a suppository. Doctors usually do not recommend antiemetics for infants, but depending upon the situation, older children may be prescribed an antiemetic (antinausea) medication in a lower dosage. Antidiarrhea medications are not usually recommended if the infection is associated with a toxin that causes the diarrhea. The most common antidiarrheal agents for people older than 3 years of age include over-the-counter (OTC) medications such as diphenoxylateatropine (Lomotil, Lofene, Lonox) or loperamide hydrochloride (Imodium).

Gastroenteritis Home Care

Home care for gastroenteritis includes: o o o o o o o o o o Drink plenty of fluids. Oral rehydration therapy for older children and adults: Drink clear liquids only, such as water, sports drinks (best), fruit juice and dilute tea. Drink small quantities of fluids frequently, such as 2 tablespoons of fluid every 5 minutes. The absence of food allows the intestines to rest. May be able to advance to full liquid diet once symptoms improve Effective to treat mild to moderate dehydration Avoid milk and dairy products Wash your hands after bowel movements. Acetaminophen for pain or fever Nonsteroidal anti-inflammatory medications for pain or fever: Ibuprofen (Motrin, Advil, Nuprin, NeoProfen) Ketoprofen (Actron, Orudis, Oruvail) Naproxen (Anaprox, Naprosyn, Aleve) Nonprescription medications for diarrhea: Loperamide (Imodium A-D) Bismuth subsalicylate (Pepto-Bismol) Nonprescription medications for vomiting:

o o o o o of infection.

Meclizine (Bonine) Dimenhydrinate (Dramamine) Bismuth subsalicylate (Pepto-Bismol) Take prescribed medications as directed: Don't skip doses of your medication. This makes them less effective. Be aware of the common side effects that may be caused by your medication. Wash the buttocks of infants after a bowel movement, in order to prevent diaper rash and spread

For more information:

Bacterial gastroenteritis home care Viral gastroenteritis home care Salmonella infection home care Shigella infection home care Campylobacter enteritis home care Diarrhea home care Giardia infection home care

Gastroenteritis Abdominal Pain Adults

Gastroenteritis should not cause severe or persistent abdominal pain in adults. For mild pain, home treatment measures include: o o o o o o Avoid aspirin, spicy foods, alcohol, caffeine, and smoking. Avoid enemas and laxatives. Try a heating pad or hot water bottle on the abdomen, or a warm bath. Drink clear liquids only and avoid dairy products for 24 hours. Then slowly advance to a soft diet For vomiting, take small but constant sips of water until vomiting stops. Lie down and rest. Try an acid-blocker medicine like: Zantac Pepcid Tagamet Prilosec Try an antacid medication such as: Maalox Mylanta Acetaminophen for pain or fever

before returning to solid foods.

Gastroenteritis Abdominal Pain Children

Gastroenteritis should not cause severe or persistent abdominal pain in children. For mild pain, home treatment measures include: o o o o o o Avoid aspirin, spicy foods and caffeine. Avoid exposing the child to cigarette smoke. Avoid enemas and laxatives. Try a heating pad or hot water bottle on the abdomen, or a warm bath. Drink clear liquids only and avoid dairy products for 24 hours. Then slowly advance to a soft diet For vomiting, take small but constant sips of water until vomiting stops. Get plenty of rest. Older children can try an acid-blocker medicine like: Zantac Pepcid Tagamet Prilosec Try an antacid medication such as: Maalox Mylanta Take any prescription medications as directed. Use acetaminophen for pain control. Avoid aspirin and ibuprofen.

before returning to solid foods.

Gastroenteritis Diarrhea in Adults

Home treatment of diarrhea in adults with gastroenteritis includes hydration and dietary therapy. Hydration Those who are able to drink liquids can restore lost water and salt with oral rehydration therapy (ORT). ORT fluids are usually used in children, but are also effective for adults. These include: Infalyte Lytren Naturalyte Pedialyte Rehydralyte ReVital Generic drugstore brands

Additional ORT fluids include:

Soft drinks without caffeine Sports drinks (Gatorade) Tea Water

Dietary Therapy ORT is most important if you have vomiting with the diarrhea. Once vomiting andnausea resolves, eat bland foods first. If you tolerate bland food, then you can resume a normal diet. Foods that may help diarrhea:

Applesauce Bananas Bread Cereal Crackers Mashed potatoes Noodles Oatmeal Potatoes Rice Strained carrots Wheat Yogurt

Items that may worsen diarrhea include:

Alcohol Caffeine Concentrated fruit juices High-sugar foods (junk food) Cow's milk Spicy foods Sugar substitutes

Gastroenteritis Diarrhea in Children

Home treatment of diarrhea in children with gastroenteritis includes hydration and dietary therapy. Hydration Those who are able to drink liquids can restore lost water and salt with oral rehydration therapy (ORT). ORT fluids used in children include: Infalyte Lytren Naturalyte Pedialyte Rehydralyte ReVital Generic drugstore brands

Additional ORT fluids for older children include:

Soft drinks without caffeine Sports drinks (Gatorade) Tea Water

Strategies for breast-fed infants under 6 months include:

Continue breast feeding as much as your baby desires. Provide additional ORT fluids to supplement breast milk. If vomiting occurs, provide small amounts of ORT fluids every 30-60 minutes. Prevent diaper rash by changing diapers frequently and apply Vaseline to the skin. Watch for symptoms of dehydration.

Strategies for bottle-fed infants under 6 months:

Give your child normal amounts of formula. Provide as much ORT fluids as your baby desires. If vomiting occurs, provide small amounts of ORT fluids every 30-60 minutes. If vomiting occurs, try a lactose-free formula.

Prevent diaper rash by changing diapers frequently and apply Vaseline to the skin. Watch for symptoms of dehydration.

Strategies for children over 6 months:

Provide a bland diet. Provide as much ORT fluids as your baby desires. If vomiting occurs, provide small amounts of ORT fluids every 30-60 minutes. Prevent diaper rash by changing diapers frequently and apply Vaseline to the skin. Watch for symptoms of dehydration.

Dietary Therapy ORT is most important if you have vomiting with the diarrhea. Once vomiting andnausea resolves, provide bland foods first. If bland foods are tolerated, then you resume a normal diet. Foods that may help diarrhea:

Applesauce Bananas Bread Cereal Crackers Mashed potatoes Noodles Oatmeal Potatoes Rice Strained carrots Wheat Yogurt

Items that may worsen diarrhea include:

Alcohol Caffeine Concentrated fruit juices High-sugar foods junk food

Cow's milk Spicy foods Sugar substitutes

Gastroenteritis Pain and Fever Adults

Medications commonly used to control pain and fever in adults with gastroenteritis include: o o o o Acetaminophen Nonsteroidal anti-inflammatory drugs: Aspirin Ibuprofen Naproxen Ketoprofen

Acetaminophen

hours. Aspirin

Acetaminophen decreases fever and pain, but does not help inflammation. Adult dosing is 2 regular strength (325 mg) every 4 hours or 2 extra-strength (500 mg) every 6 Maximum dose is 4,000 mg per day. Avoid this drug if you have alcoholism, liver disease or an allergy to the drug. See the package Common brand names include Tylenol, Panadol, and many others.

instructions.

Aspirin decreases pain, fever and inflammation. It is a nonsteroidal anti-inflammatory medication (NSAID). Adult dosing is two regular strength (325 mg) every 4 hours with food. There are numerous products that contain aspirin. Follow the package instructions and NSAID precautions (below).

Ibuprofen

Ibuprofen decreases pain, fever and inflammation. It is a nonsteroidal anti-inflammatory medication (NSAID). Adult dosing is 200-400 mg every 4-6 hours. Do not exceed 1,200 mg per day without a doctor's recommendation.

Brand names include Advil, Motrin and Nuprin. Follow the package instructions and NSAID precautions (below).

Naproxen

Naproxen decreases pain, fever and inflammation. It is a nonsteroidal anti-inflammatory medication (NSAID). Adult dosing is 200 or 220 mg twice a day with food. Do not exceed 500 mg per day. Its brand name is Aleve. Follow the package instructions and NSAID precautions (below).

Ketoprofen

Ketoprofen decreases pain, fever and inflammation. It is a nonsteroidal anti-inflammatory medication (NSAID). Adult dosing is 12.5 mg every 4-6 hours with food. Do not exceed 75 mg per day. Its brand name is Orudis KT. Follow the package instructions and NSAID precautions (below).

NSAID Precautions

o o o o o o o o

Avoid using alcohol when taking any of these medications. Do not mix prescription and non-prescription NSAIDS unless directed to do so by your doctor. NSAIDS can interact with other blood thinners, such as Coumadin, and cause bleeding Ask your doctor before using an NSAID if you are pregnant or breastfeeding. Ask your doctor before using an NSAID if you have a history of: Allergy to aspirin Asthma Peptic ulcer disease Stomach ulcers Esophageal ulcers Bleeding problems Liver disease Kidney disease

complications.

Gastroenteritis Pain and Fever Children

Common medications used at home for pain and fever in children with gastroenteritis include: Acetaminophen: the best drug to use when the intestinal tract is irritated Ibuprofen: may be used in children, but is more likely to cause side effects in this condition. Ask

your doctor first. Acetaminophen

Acetaminophen decreases fever and pain, but does not help inflammation. Dosing is 10-15 mg per kilogram (5-7 mg per pound) of body weight every 4-6 hours, up to the Do not exceed the maximum daily dose. Acetaminophen products come in various strengths. Always follow the package instructions. Avoid this drug in children with liver disease or an allergy to acetaminophen. Common acetaminophen products include Tylenol, Panadol and many others.

adult dose.

Ibuprofen

Ibuprofen decreases pain, fever and inflammation. It is a nonsteroidal anti-inflammatory medication (NSAID). Dosing for children over 6 months of age is 7-10 mg per kilogram (4-5 mg per pound) of body Do not exceed the maximum daily dose.

weight every 6 hours, up to the adult dose. Always follow the package instructions.

Avoid this drug in children with liver, kidney, stomach or bleeding problems. Brand names include Advil, Motrin and Nuprin.

Gastroenteritis Vomiting in Adults

Home care for vomiting in adults with gastroenteritis: Drink clear liquids only, such as water, sports drinks, fruit juice and dilute tea. Sports drinks are Drink small quantities of fluids frequently. In general, two tablespoons of fluid every 5 minutes is Avoid milk and dairy products for 3 days. Avoid liquids that irritate the stomach, such as citrus juice, alcohol and coffee. best. The absence of food allows the intestines to rest. an effective strategy.

If nausea or vomiting continues despite the above, consider one of the nonprescription medicines Once vomiting and nausea resolves, start bland foods first. If you tolerate bland food, then you

listed below. can resume a normal diet. Nonprescription medications for vomiting include:

Meclizine (Bonine) Dimenhydrinate (Dramamine) Bismuth subsalicylate (Pepto-Bismol)

Gastroenteritis Vomiting in Children

Home treatment of vomiting in children with gastroenteritis includes hydration and dietary therapy. Those who are able to drink liquids can restore lost water and salt with oral rehydration therapy (ORT). ORT fluids used in infants include: Infalyte Lytren Naturalyte Pedialyte Rehydralyte

ORT fluids used in older children include:

Sports drinks (Gatorade) Broth Dilute fruit juices Flat soda Weak tea with sugar

Strategies for breast-fed infants younger than 6 months:

as: o

If the infant tolerates breast milk, continue breast-feeding in small amounts very frequently. Provide additional ORT fluids to supplement breast milk. Feed very small amounts every 30-60 minutes, or try giving small amounts more frequently, such Children up to 5 kg (11 lb): give 5 ml (1 teaspoon) every 5 minutes

Children 5-10 kg (11-22 lb): give 10 ml (2 teaspoons) every 5 minutes Watch for dehydration: dry mouth, decreased urination, dark yellow urine and lack of tears.

Strategies for formula-fed infants younger than 6 months:

o o

If the infant tolerates formula, continue to provide small amounts very frequently. Provide additional ORT fluids to supplement formula. Try giving small amounts more frequently, such as: Children up to 5 kg (11 lb): give 5 ml (1 teaspoon) every 5 minutes Children 5-10 kg (11-22 lb): give 10 ml (2 teaspoons) every 5 minutes Watch for dehydration: dry mouth, decreased urination, dark yellow urine and lack of tears.

Strategies for children over 6 months:

o o o

Provide as much ORT fluids as your child desires. If vomiting occurs, provide small amounts of ORT fluids more frequently: Children 10-20 kg (22-44 lb): 15 ml (1 tablespoon) every 5 minutes Children 20-40 kg (44-88 lb): 22 ml (1 and 1/2 tablespoons) every 5 minutes Children 40 kg (88 lb) and over: 30 ml (2 tablespoons) every 5 minutes Watch for dehydration: dry mouth, decreased urination, dark yellow urine and lack of tears.

Dietary Therapy Most children with vomiting improve in a few hours and symptoms usually resolve in one day. Once vomiting and nausea resolves, provide bland foods first. If bland foods are tolerated, then you resume a normal diet. Foods that are easiest to tolerate include:

Crackers Oatmeal Jell-O Soft foods Yogurt

Foods to avoid include:

Concentrated fruit juices Junk foods Milk products Recently introduced foods Spicy foods

Nonprescription medicines for vomiting should only be used under the direction of your doctor.

Gastroenteritis Warning Signs

Notify your doctor if you have gastroenteritis and any of the following: o o o o o o Fainting Jaundice: Yellow skin Yellow eyes Unintentional weight loss No improvement after 3 days Diarrhea that contains pus Blood in the stool: Black stool Rectal bleeding Red stools Repeated vomiting for more than 8 hours Fever over 101 degrees F (38.3 C) Decreased urination: Urinating less than 3 times per day Worsening abdominal pain

Gastroenteritis Risk Factors

Risk factors for gastroenteritis include: o o Drinking well water Eating undercooked food, especially seafood Improperly stored food Travel to high risk areas Any condition that causes a weakening of the immune system such as: Diabetes Organ transplant

o o o o o

Chemotherapy: The administration of medicines that kill cancer cells. AIDS Living around poor sanitation* Living in close quarters: Army barracks Dormitories Nursing homes

Acute gastroenteritis, also called infectious diarrhea, causes watery diarrhea, vomiting and abdominal cramping. Symptoms last for up to 10 days and usually resolve without treatment, according to the University of Maryland Medical Center. Transmission occurs by contact with an infected person or ingesting food or water contaminated by a virus, bacteria or parasites, notes the Centers for Disease Control and Prevention. Weakend Immune System Acute gastroenteritis occurs in all age groups throughout the world, but people with weakened or immature immune systems have more severe symptoms, according to MayoClinic.com. The immune system matures at approximately age 6 and becomes less effective later in life, so infants, young children and the elderly tend to become sicker than other individuals. Patients with immune deficiency disease such as HIV or AIDS may also suffer more severe symptoms.

Person-to-Person Contact Transmission can occur by contact with an infected person or something the person has touched, according to the CDC. People in densely populated conditions, including cruise ships, day care centers, nursing homes and crowded households are at highest risk. Organisms can be transmitted by direct contact or by touching objects such as handrails, elevator buttons or shared utensils, notes CDC. Prevention measures include frequent hand-washing; cleaning common surfaces; avoiding direct contact with an ill person, if possible; and keeping hands away from the mouth can help to prevent spreading of the disease. Contaminated Food or Water Food or water contaminated with a virus, bacteria or parasite can cause acute gastroenteritis in people who ingest it, according to the Merck Manuals Online Medical Library. Food contamination may occur during production, preparation or storage. Contaminated water may come from a faulty storage system, a person or animal defecating in a pond or swimming pool or an untreated water source. Prevention measures include hand-washing during food preparation; proper cleaning of cooking utensils and surfaces; thorough cooking of foods; storing foods at proper temperatures; and returning dairy and mayonnaise-based foods to the refrigerator promptly, according to the University of Maryland Medical Center. High-risk foods include raw seafood, undercooked meat and eggs, unwashed raw fruits and vegetables, unpasteurized juices, and food left out of the refrigerator for more than a few minutes. Travelers should drink bottled water, avoid raw or uncooked foods and consider taking a vaccine for rotavirus, a common source of gastroenteritis,

Gastroenteritis Prevention
Prevention of gastroenteritis includes: Wash your hands after using the toilet. Avoid eating raw clams or oysters. Do not drink unpasteurized milk. Do not share food utensils.

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Wash your hands after handling raw meat, seafood, or poultry. Make sure all meat, poultry and fish products are well cooked. Travelers can take 2 tablets of Pepto-Bismol with each meal and at bedtime. Travelers to developing countries should avoid: Foods that are not steaming hot Raw vegetables Fruit they have not peeled themselves Tap water, including ice

Gastroenteritis Complications
Complications of gastroenteritis include: o o o o o Sepsis From secondary bacterial infection Shock Often due to severe dehydration Pseudomembranous enterocolitis Usually only seen in those who are taking antibiotics Gastrointestinal bleeding Dehydration Electrolyte imbalance: Often low potassium or hypokalemia Often high sodium or hypernatremia

Gastroenteritis Anatomy
To better understand gastroenteritis, it helps to understand the anatomy of the intestines. The intestine is a long, continuous, tube inside the body. It lets the body absorb nutrients from food and liquids. The intestine is about 22 feet long. It includes the large intestine (colon) and the small intestine. The small intestine has three parts: o o o intestine) Ileum: Lower portion of the small intestine that connects to the cecum (first part of the large Duodenum: Connects to the stomach Jejunum: Middle portion of the small intestine

The large intestine is also known as the colon. It is the last portion of the intestine. The colon has several parts, including:

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Cecum: The portion of the colon that connects to the ileum (small intestine). The appendix is a Ascending colon: The first section after the small intestine, located on the right side Transverse colon: Sits horizontally across the upper abdomen Descending colon: Located on the left side of the abdomen Sigmoid: A short, S-shaped section above the rectum Rectum: The lowest internal part of the colon

finger-like pouch that comes off of the cecum.

Intestinal anatomy:

Entire gastrointestinal tract Intestines and other abdominal organs Blood vessels of the intestines The appendix is a small pouch that protrudes from the wall of the large intestine. It is located at

the point where the small intestine turns into the large intestine.

Management of Gastroenteritis
by Warren P. Silberstein, M.D. 02/14/97 Gastroenteritis is the medical term for the illness characterized by vomiting, diarrhea, abdominal pain, and fever. Some people refer to it as intestinal flu, but it is not related to the influenza virus. Most gastroenteritis is caused by viruses such as Rotavirus, Norwalk, and others, but food poisonings by bacteria like Salmonella also cause gastroenteritis. The treatment of gastroenteritis is a perfect example of the fact that infants are not just small children, and that children are not just little adults. For all age groups the major risk of gastroenteritis is dehydration, but for infants and small children dehydration is a much more serious risk than for older children and adults.

Dehydration can occur in adults if they are vomiting and unable to retain fluids, but adults rarely become dehydrated from diarrhea except with extreme cases such as with cholera. Young children and infants can dehydrate much more quickly because they are smaller and therefore a smaller amount of body fluid loss will result in dehydration. In adults, the focus of treatment is on symptom relief. Adults have responsibilities and plans where frequent bathroom breaks would be embarrassing and a major inconvenience. Babies in diapers don't really care how frequently they go. The main medications for adults are Kaopectate, Lomotil, and Imodium. Medicines like Kaopectate work by binding water in the stool and making the stool firmer. The mechanism of action is very similar to making cement. Medications like Lomotil and Imodium work by slowing down the movement of the intestines. This results in less frequent bowel movements and decreased cramping. The important thing to understand about these medications is that they don't prevent water loss, so they don't prevent dehydration. And even though they provide symptomatic relief, they don't make you get over the illness any faster. Also, since the narcotic type medications like Lomotil and Imodium slow down intestinal movement, if the intestine is severely inflamed this can result in huge amounts of fluid being retained in the intestines instead of the body circulation. This retention of fluids in the intestines can be dangerous in an infant. It is generally not advisable to use the narcotic type medications in a child under 2 years of age. In infants, the focus of treatment for gastroenteritis must be prevention of dehydration. This makes control of vomiting the first priority. A child who is unable to retain fluids by mouth will dehydrate very quickly. The first step in management of vomiting is to put the stomach to complete rest. When children first become ill they may vomit multiple times in a row until the stomach is empty. After the initial phase calms down the stomach should be rested by not taking anything by mouth for at least 1 hour. Many parents who become anxious about getting a child to retain some food or drink and worry about a child going without a meal for too long keep pushing food and fluids on the sick child, but this is a mistake because it only ends up coming back up. After the resting phase the child should be started slowly on clear fluids, starting as small as 1 teaspoon every 15 minutes and gradually increasing to 4 ounces every few hours. If a child cannot tolerate even small amounts of clear fluids he needs medical attention. The ideal clear fluid is an electrolyte solution like Pedialyte, Kaolectrolyte, or otheroral electrolyte rehydration fluid. which will replace the salts lost from vomiting and diarrhea. For older children the frozen electrolyte ice pops like Revitalice or the new Pedialyte brand might be helpful. Herb tea, water, and clear juices may serve as clear fluids as well, but they won't replenish the lost electrolytes which is essential for preventing dehydration. A fluid is only considered clear if you can see through it when you hold it up to light. Too much sugar, as might occur with excessive juice intake, can aggravate diarrhea. Soda, unless it is completely flat, may aggravate the vomiting and the pains by filling the stomach with gas. Food and milk must be avoided until the vomiting is completely resolved since anything that sits in the stomach can provoke vomiting. Management of diarrhea in infants requires making sure that the infant drinks enough fluids, preferably an electrolyte solution like Pedialyte, to make up for the fluid losses. There isn't any medication or treatment that makes the intestines heal faster, but as long as you prevent dehydration that allows time for the body to recover from the illness. If a child is not severely ill, is not vomiting, and has an appetite, it is okay for him to eat bland foods and drink his milk. If a child is active and in good spirits you can be reasonably sure that he is not dehydrated. If he has dry diapers, fever, lethargy, cries without tears, or has dry mouth, these are signs of dehydration that require medical attention.