Gastroenteritis

Gastroenteritis (also called intestinal flu, traveler's diarrhea, viral enteritis, and food poisoning) is an inflammation of the stomach and small intestine that is self-limiting. The bowel reacts to any of the varied causes of gastroenteritis with hypermotility, producing severe diarrhea and secondary depletion of intracellular fluid.

Gastroenteritis occurs in people of all ages. It's a major cause of morbidity and mortality in underdeveloped nations. In the United States, this disorder ranks second to the common cold as a cause of lost work time and fifth as the cause of death among young children. It can be life-threatening in elderly and debilitated people.

Causes

Many different viruses can cause gastroenteritis, including rotaviruses, adenoviruses, caliciviruses, astroviruses, Norwalk virus, and a group of Noroviruses. Viral gastroenteritis is not caused by bacteria (such as Salmonella or Escherichia coli) or parasites, or by medications or other medical conditions, although the symptoms may be similar. Your doctor can determine if the diarrhea is caused by a virus or by something else.

Signs and Symptoms

Patient history commonly reveals the acute onset of diarrhea accompanied by abdominal pain and discomfort. The patient may complain of cramping, nausea, and vomiting. He may also report malaise, fatigue, anorexia, fever, abdominal distention, and rumbling in the lower abdomen. If diarrhea is severe, he may experience rectal burning, tenesmus, and bloody mucoid stools.

Investigate the patient's history to try to determine the cause of the signs and symptoms. Ask about ingestion of contaminated food or water. The cause may be apparent if the patient reports that others who ingested the same food or water have similar signs and symptoms. Also ask about the health of other family members and about recent travels.

Inspection may reveal slight abdominal distention. On palpation, the patient's skin turgor may be poor, a sign of dehydration. Auscultation may disclose hyperactive bowel sounds and, if the patient is dehydrated, orthostatic hypotension or generalized hypotension. Temperature may be either normal or elevated.

Diagnostic tests

Laboratory studies are used to identify the causative bacteria, parasites, or amoebae. These studies include Gram stain, stool culture (by direct rectal swab), or blood culture.

Treatment

Medical management is usually supportive, consisting of bed rest, nutritional support, increased fluid intake and, occasionally, antidiarrheal therapy. If gastroenteritis is severe or affects a young child or an elderly or debilitated person, hospitalization may be required. Treatment may include I.V. fluid and electrolyte replacement and administration of antidiarrheals, antiemetics, and antimicrobials.

Antidiarrheals, such as bismuth sub salicylate, are typically used as the first line of defense against diarrhea. If necessary, other antidiarrheals, such as camphorated opium tincture (paregoric), diphenoxylate with atropine, and loperamide, may be ordered.

Antiemetics (oral. I.V., or rectal suppository), such as prochlorperazine and trimethobenzamide, may be prescribed for severe vomiting. Antiemetics should be avoided in patients with viral or bacterial gastroenteritis

Specific antibiotic administration is restricted to patients who have bacterial gastroenteritis, as identified by diagnostic testing.

Prevention

• Use separate personal items around your home. Avoid sharing eating utensils, glasses and plates. Use separate towels in the bathroom.
• Keep your distance. Avoid close contact with anyone who has the virus, if possible.
• Make sure child care centers have separate rooms for changing diapers and preparing or serving food. The room with the diaper-changing table should have a sink as well as a sanitary way to dispose of diapers.