Gastroenteritis

Question 1

Viral causes of gastro

Answer 1

• Rotavirus: seasonal peak in Autumn and Winter
• Adenovirus: 7-17% of cases require admission
• Norovirus
• CMV enteritis: consider in immunocompromised patients

Question 2

Bacterial causes of gastro (5-10%)

Answer 2

• Salmonellaspp.
• Campylobacter jejuni
• Yersinia enterocolitica
• Escherichia coli
• Shigella
• C. difficile: follows antibiotic therapy
• Entamoeba histolytica: consider in developing countries

Question 3

Parasitic causes of gastro

Answer 3

• Cryptosporidium: consider in immunocompromised patients

* Giardia: commonly a cause of persistent diarrhoea with flatulence and bloating

Question 4

DDx of gastro

Answer 4

• Appendicitis
• UTI
• Sepsis
• Surgical abdomen: intussusception, Hirschprung’s, malrotation, pyloric stenosis
• HUS
• DKA
• Malabsorptive disorders: Coeliac disease, CMPI

Question 5

What does doughy skin suggest?

Answer 5

Hypernatraemia

Question 6

What are some initial Ix you might do in severely dehydrated/unwell, or high loss gastros?

Answer 6

Glucose, UEC, ABG/VBG

Question 7

What are other options for feeding if a patient can’t tolerate normal oral intake?

Answer 7

• Slower, smaller feeds
• NGT
• If not tolerating NGT: 
	○ Slow rate
	○ Give ondansetron 
	○ Then IV

Question 8

Why is NGT preferred to IV?

Answer 8

Safer: a) electrolytes b) skin (not necessarily less invasive)

Question 9

How can feeding affect breathing?

Answer 9

Inc WOB:

• Stomach pushes on diaphragm
• Esp in smaller children, requires a lot of energy to feed

Question 10

What is the most preferred oral rehydration solution? How do ORSs work?

Answer 10

• Hydralyte

- ORS works via glucose-facilitated sodium transport

Question 11

What should you consider if there is persistent diarrhoea after re-introduction of feeds?

Answer 11

lactose intolerance

Question 12

What pharmacotherapy is recommended for gastro?

Answer 12

• No treatment with antidiarrhoeals is recommended
• Most bacterial infections do not require Abx even if there is presence of blood or mucous
• Ondansetron once

• Indications for Abx treatment
○ Salmonella/camp/shigella/c.difficile/giardia
○Sepsis, extra-intestinal spread of bacterial infection

Question 13

Which patients with gastro should be admitted?

Answer 13

Patients at high risk of dehydration:

• age (< 6 months)
• high frequency of diarrhoea (> 8 per 24 hours)
• vomiting (> 4 per 24 hours) should be observed

and high risk conditions e.g. short gut