GI - gastroenteritis

Question 1

define infective gastroenteritis

Answer 1

a temporary disorder due to an enteric infection.

most commonly caused by viruses, but can also be due to bacterial or parasitic infection.

typically characterised by sudden onset diarrhoea with or without vomiting.

Question 2

3 viral causes of gastroenteritis

Answer 2

1. rotavirus -mc in children
2. norovirus
3. adenovirus

Question 3

what is the Most common viral cause of infantile gastroenteritis

Answer 3

rotavirus

uncommon in adults due to long lasting immunity

Question 4

what vaccine for rotavirus gastroenteritis

Answer 4

The rotavirus oral vaccine (Rotarix®) is part of the national vaccination programme in the UK. It is given at 8 and 12 weeks

Question 5

how does rotavirus gastroenteritis spread

Answer 5

faecal oral route or by environmental contamination, incidence peaks over the winter months.

Question 6

what is the commonest viral cause of gastroenteritis in all age groups

Answer 6

norovirus

Question 7

what does norovirus refer to

Answer 7

Refers to a group of single stranded RNA viruses.

Question 8

how does norovirus gastroenteritis spread

Answer 8

faecal oral route or by environmental contamination.

Question 9

what is adenovirus known for

Answer 9

more commonly known for causing infections of the respiratory system. However, they can also cause gastroenteritis, especially in those under 2 years of age.

Question 10

2 bacterial causes of gastroenteritis

Answer 10

1. Campylobacter
2. E coli

Question 11

most commonly reported bacterial cause of gastroenteritis in the UK

Answer 11

Campylobacter

Question 12

describe campylobacter gastroenteritis

Answer 12

It can cause bloody diarrhoea and is usually due to consumption of undercooked meat and unpasteurised milk.

Question 13

which strains of e coli are harmful

Answer 13

(verocytotoxin producing E-coli aka VETC)

Question 14

what are some life threatening complications of e coli

Answer 14

haemorrhagic colitis and haemolytic uraemic syndrome

Question 15

how is e coli gastroenteritis spread

Answer 15

through contaminated food, person to person contact and contact with infected animals

Question 16

sx of gastroenteritis

Answer 16

Sudden onset of loose/watery stool with or without vomiting
Abdominal pain/cramps
Mild fever
Recent contact with someone with diarrhoea or vomiting.

Question 17

what is the risk for children w gastroenteritis

Answer 17

dehydration

Question 18

which groups of children are at greatest risk of dehydration when they have gastroenteritis

Answer 18

Young children (especially under 6months).

Children who have passed >5 diarrhoeal stools in the last 24 hours.

Children who have vomited >2x in the last 24 hours.

Children who have stopped breast feeding during the illness.

Question 19

signs and symptoms of severe clinical shock due to dehydration

Answer 19

Decreased level of consciousness

Pale or mottled skin

Cold extremities

Tachycardia

Tachypnoea

Weak peripheral pulses

Prolonged capillary refill time

Hypotension (decompensated shock)

Question 20

signs and symptoms of clinical dehydrtaion

Answer 20

Appears to be unwell or deteriorating

Altered responsiveness

Decreased urine output

Skin colour unchanged

Warm extremities

Sunken eyes

Dry mucous membranes

Tachycardia

Tachypnoea

Normal peripheral pulses

Normal capillary refill time

Reduced skin turgor

Normal blood pressure

Question 21

when should ddx be considered for gastroenteritis

Answer 21

Temperature higher than 38oC if < 3months or higher than 39oC if >3months.
Breathlessness or tachypnoea
Altered GCS
Meningism
Blood/mucous in stool
Bilious (green) vomit
Severe/localised abdominal pain.
Abdominal distension or guarding.

Question 22

what is main investigation for gastroenteritis

Answer 22

stool sample

Question 23

when is stool sample sent for gastroenteritis

Answer 23

IF:
- Septicaemia is suspected
or
- blood and/or mucus is present in the stool
or
- the child is immunocompromised

Question 24

which bloods are done for gastrotneritis

Answer 24

Na+, K+, Cr, Ur and glucose

Question 25

at what point do u look at bloods for gastroenteritis

Answer 25

if : - IV fluids are going to be used. - There are symptoms/signs of hypernatraemia

Question 26

what to do if shock is suspected in gastroenteritis

Answer 26

Measure acid-base status and chloride concentration

Question 27

immediate management for gastroenteritis if px not clinically dehydrated

Answer 27

Continue breast feeding/other milk feeds Encourage fluid intake Discourage fruit juices and carbonated drinks especially if the child is at risk of dehydration. Offer oral rehydration salt solution (ORS) as supplemental fluid to those at risk of dehydration.

Question 28

immediate management for gastroenteritis if px is clinically dehydrated

Answer 28

first line - oral therapy last line - IV therapy

Question 29

when to use IV therapy for gastroenteritis

Answer 29

if: - Shock is suspected - In a child with any red flag symptoms - If there is evidence of dehydration despite use of oral rehydration therapy - If the child persistently vomits when ORS solution is given either orally or via NG tube.

Question 30

how to give oral therapy for gastroenteritis

Answer 30

Give ORS solution: 50 ml/kg over 4 hours to replace the defecit plus maintenance fluid* Give the ORS solution frequently in small amounts e.g. 5ml every 5 minutes and consider supplementation with their usual fluids (including milk feeds or water, but not fruit juices or carbonated drinks)

Question 31

what to do if child refuses oral therapy in gastroenteritis

Answer 31

NG tube

Question 32

what to do after rehydration in gastroenteritis

Answer 32

Advise parents to give full strength milk straight away, and slowly re-introduce the child’s solid food. avoid juice advice on hand washing and avoiding sharing of towels. The child should not return to their school/nursery until at least 48 hours have passed child should not swim for 2 weeks after the last episode

Question 33

how long does diarrhoea sx last in gastroentieris

Answer 33

Diarrhoea symptoms tend to last 5-7 days with the majority stopping within 2 weeks.

Question 34

how long do vomiting sx last in gastroenteritis

Answer 34

Vomiting tends to last 1-2 days with the majority stopping within 3 days

Question 35

what is a serious complication of acute infectious gastroenteritis

Answer 35

Haemolytic uraemic syndrome (HUS) occurs mostly in young children and the elderly. can be a life-threatening complication causing: acute renal failure, haemolytic anaemia