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Acute Gastroenteritis
Acute gastroenteritis is a disease characterized by
changes in the character and frequency of stool.
It can be defined as the passage of a greater number of
stools of decreased form from the normal lasting less
than 14 days.
Generally associated with other signs or symptoms
including nausea, vomiting, abdominal pain and cramps,
increase in intestinal gas-related complaints, fever,
passage of bloody stools (dysentery), tenesmus
(constant sensation of urge to move bowels), and fecal
urgency. (1)
(1) Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology.
American Journal of Gastroenterology. 1997 Nov;92(11):1962-75.
Acute Gastroenteritis
Perform initial assessment
Dehydration
Duration (>1 day)
Inflammation (indicated by fever, presence
of blood in stool, tenesmus) (2)
(2) Acute Infectious Diarrhea. Nathan M. Thielman, M.D., M.P.H., and Richard L. Guerrant, M.D. The New England
Journal of Medicine. 2004; 350:38-47.
Acute Gastroenteritis
Complete blood count can be obtained to look
for anemia, hemoconcentration, or an abnormal
white blood cell count. (4)
Measurements of serum electrolyte
concentrations and blood urea nitrogen and
serum creatinine levels can be used to
determine the extent of fluid and electrolyte
depletion and its effect on renal function. (4)
(4) Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 8th edition. 2006. Feldman, Mark
MD. Volume II. p169.
Acute Gastroenteritis
Provide symptomatic treatment
Rehydration
Treatment of symptoms (if necessary,
loperamide if diarrhea is not inflammatory
or bloody) (2)
(2) Acute Infectious Diarrhea. Nathan M. Thielman, M.D., M.P.H., and Richard L. Guerrant, M.D. The New England
(6) World Gastroenterology Organisation (WGO). WGO practice guideline: acute diarrhea. Munich, Germany: World Gastroenterology
Organisation (WGO); 2008 Mar.
(2) Acute Infectious Diarrhea. Nathan M. Thielman, M.D., M.P.H., and Richard L. Guerrant, M.D. The New England Journal of Medicine. 2004; 350:38-47
(2) Acute Infectious Diarrhea. Nathan M. Thielman, M.D., M.P.H., and Richard L. Guerrant, M.D. The New England Journal of Medicine. 2004; 350:38-47
Immunocompromised patients
If symptoms recur or are uncontrolled despite hydration
and antimicrobial treatment....
If evidence of colitis is present,
Do:
– Proctosigmoidoscopy with biopsy of lesions with
attention to CMV, mycobacteria, Adenovirus, Fungi,
Herpes simplex
(1) Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. American
Journal of Gastroenterology. 1997 Nov;92(11):1962-75.
Immunocompromised patients
If symptoms recur or are uncontrolled despite
hydration and antimicrobial treatment....
If evidence of colitis is NOT present,
Do:
-Gastroduodenoscopy with biopsy, Smears and
culture for special parasites plus
proctosigmoidoscopy
(1) Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. American
Journal of Gastroenterology. 1997 Nov;92(11):1962-75.
Acute Gastroenteritis
When to discharge?
– Stable Vital signs
– Maintains a sufficient fluid intake
– Able to eat meals adequately
– Able to take medications (if still indicated) (6)
(6) World Gastroenterology Organisation (WGO). WGO practice guideline: acute diarrhea. Munich, Germany: World Gastroenterology
Organisation (WGO); 2008 Mar.
Patient Education
Many diarrheal diseases can be prevented by
following simple rules of personal hygiene and
safe food preparation.
Hand-washing with soap is an effective step in
preventing spread of illness and should be
emphasized for caregivers of persons with
diarrheal illnesses.
As noted above, human feces must always be
considered potentially hazardous, whether or not
diarrhea or potential pathogens have been
identified. (3)
(3) Practice Guidelines for the Management of Infectious Diarrhea. Infectious diseases Society of America. Clinical Infectious Diseases 2001; 32:331–50.
Patient Education
(3) Practice Guidelines for the Management of Infectious Diarrhea. Infectious diseases Society of America. Clinical
Infectious Diseases 2001; 32:331–50.
THANK YOU!
Clinical Pathway for Acute Gastroenteritis with Severe
dehydration
1st 30 minutes 2nd 30 minutes to 2 hrs 2 hrs to 24 hours
I
C
S
Clinical Pathway for Acute Gastroenteritis with
Severe dehydration
1st 30 minutes 2nd 30 minutes to 2 2 hrs to 24 hours
hrs
T IV Line or Central vein catheter for IV Hydration Adjust IV fluids
rapid fluid delivery correct fluid and accordinglycorrect
R
Oxygen by nasal cannula (if electrolyte fluid and electrolyte
E tachpneic/ dyspneic) disturbances disturbances start
A Elevate patient’s feet and legs (if oral hydration (if
with hypotension tolerated) of
T
preferred diet
M
E
N
T
Clinical Pathway for Acute Gastroenteritis with
Severe dehydration
1st 30 minutes 2nd 30 minutes to 2 hrs 2 hrs to 24 hours