Gastroenteritis

Question 1

What is gastroenteritis?

Answer 1

Temporary disorder due to an enteric infection

→ MC caused by viruses or bacterial/parasitic infection

→ Most cases are benign and self-limiting

Question 2

Viral causes of GE

Answer 2

1. Rotavirus - MC in children
2. Norovirus - MC in ALL age groups
3. Adenovirus

Transmission:
1. Rotavirus → F-O route or environmental contamination
2. Norovirus → same as above

Question 3

Immunisations against rotavirus

Answer 3

Rotavirus oral vaccine is part of the national vaccination programme in the UK

• 8 weeks
• 12 weeks

Question 4

Bacterial causes of GE

Answer 4

1. Campylobacter (MC bacterial cause)
2. E. Coli

E. Coli transmission:

1. Contaminated food
2. P-P contact
3. Infected animals

Question 5

What does campylobacter often cause?

Answer 5

Bloody diarrhoea

Usually due to the consumption of undercooked meat or unpasteurised milk

Question 6

4 sx of GE

Answer 6

1. SUDDEN ONSET loose/water stools
2. Abdominal pain/cramps
3. Mild fever
4. Recent contact with someone with diarrhoea or vomiting

Question 7

It is important to recognise those children who are at risk of dehydration. Those at greatest risk include whom? - 4

Answer 7

1. Young children (esp < 6 months)
2. > 5 diarrhoeal stools in 24H
3. > 2 vomiting episodes in 24H
4. Stopped breastfeeding during the illness

Question 8

Indications for DDx

Answer 8

1. High-grade fever
2. Breathlessness
3. Altered GCS
4. Bilious vomit (green)
5. Severe/localised abdominal pain

Question 9

Ix

Answer 9

Mainly a clinical diagnosis

1. Stool sample for MCS + PCR
2. Bloods tests (not routine)
   → FBC/CRP - bacterial infection or sepsis
   → U&E
   → Urea
   → Creatinine

Indications for stool sample:

1. Septicaemia
2. Blood and/or mucus in the stool
3. Immunocompromised

Perform bloods if IV fluids will be used or sx of hypernatraemia (jittery, hypertonia + hyperreflexia + drowsiness)

Question 10

Acute mx of GE if dehydrated

Answer 10

Assess hydration status

If dehydrated - focus on rehydration

1. IV fluids only if: shock, red flags, failed ORT, or persistent vomiting

Oral first-line: ORS 50 ml/kg over 4 hrs to replace deficit + maintenance; give small, frequent sips

If refusing oral → NG ORS (oral rehydration solution)

Question 11

Acute mx of GE if NOT dehydrated

Answer 11

1. Continue breastfeeding/other milk feeds
2. Encourage fluid intake
3. Discourage fruit juices/carbonated drinks
4. Offer ORS as supplemental fluid to those at risk of dehdyration

Slowly re-introduce the child’s solid food

• Child should not return to school until at least 48H has passed
• No swimming for 2 weeks after the last episode

Question 12

Complications

Answer 12

1. Haemolytic uraemic syndrome - causes acute renal failure + haemolytic anaemia
2. Reiter’s syndrome (from bacterial gastroenteritis)

→ uveitis
→ reactive arthritis
→ urethritis

3. Toxic megacolon (rare but significant complication from rotavirus gastroenteritis)

Question 13

How long does diarrhoea sx last?

Answer 13

• Diarrhoea symptoms tend to last 5-7 days with the majority stopping within 2 weeks
• Vomiting tends to last 1-2 days with the majority stopping within 3 days