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ACUTE

GASTROENTERITIS
CASE PRESENTATION
Presenting Complaint:
• Nikko Tuazon, 4 years and 10 months old boy, was
brought to the hospital on 7th December 2015 at
10:00 pm due to severe diarrhea 2 days prior to
admission associated with fever and vomiting on the
day of admission.
History of presenting complaint:
• 2 days prior to admission, there was a sudden onset
of diarrhea (8-10 times per day). Watery, yellowish
to brown stools with no blood stained. Loss of
appetite and decreased oral intake
CASE PRESENTATION
History (cont.):
• His mother brought him to the clinic and the doctor prescribed him
Oral Rehydration Salt(ORS). However, the problem was not resolved.

• His mother measured the temperature at home and it was 39.2 (high
grade fever) with no rigor. His mother said that there was no rash or
joint pain and no episode of fit since he had the fever. No cough or
runny nose.
• The vomiting started on the same time with fever. It occurred once
and non-projectile. His mother described the amount of vomitous was
about half a cup, contained fluid but no blood or bile. There was no
history of changing formula milk.
CASE PRESENTATION
Systemic Review:
System Complaints
CVS No pedal edema, no cyanosis
Resp No SOB, no cough, no hemoptysis
Genitourinary Normal urine output, no hematuria
CNS No LOC, no drowsiness, no blurring visi
on, no altered speech, no headache
ENT No runny nose, no ear discharge, no fe
eding difficulty, no dysphagia
MSK No abnormal movement, no joint swelli
ng, no joint pain
Endocrine No tremor, no heat intolerance
Hematological No gum bleeding or epistaxis

Impression : No abnormal finding except for GIT part


CASE PRESENTATION
General Investigations:
• Blood Count
Result Normal range Remarks

WBC 12.84 4.5-13.5 x 10*9/L Normal


Hb 12.2 11.5-14.5 g/dL Normal
Plt 432 150-4– x 10*3 uL normal
Haematocrit 37.1 37-45% Normal

• Renal Profile
Result Normal range Remarks

Urea 3.5 1.7-6.4 mmol/L Normal


Sodium 138 135-150 mmol/L Normal
Potassium 3.80 3.5-5 mmol/L Normal
Chloride 102.0 98.0-107.0 mmol/L Normal
Creatinine 52.6 44-88 mmol/L Normal
DIAGNOSIS
Differential Diagnosis
Points to support Points to against
Appendicitis Vomiting Usually not associated
Abdominal pain with diarrhea
Usually low grade fever
Small bowel obs. Vomiting Vomitous was not bile-
(Intussusception) Diarrhea stained
Abdominal pain was not
severe
No blood-stained stool
Diabetic Ketoacidosis Abdominal pain No diarrhea
Vomiting
DIAGNOSIS
Final Diagnosis:
• Acute Gastroenteritis
• Points to support:
• Vomitting
• Diarrhea
• Fever
ACUTE
GASTROENTERITIS
• An inflammation of the mucosal membranes
of the gastrointestinal tract and is commonly
caused by viruses, bacteria, and parasites.
• A diarrheal disease of rapid onset,
manifested by nausea, vomiting, fever,
reduced oral intake, abdominal pain and
signs and symptoms of dehydration.
• Primary route of infection is oral ingestion of
the infecting organism
ACUTE
GASTROENTERITIS
Acute Gastroenteritis

Bacteria Parasites
Viruses Campylobacter Entamoeba
jejuni
Rotavirus histolytica
Salmonella
Norvirus Giardia
Shigella
Calicivirus lamblia
Astrovirus E.coli
Clostridium
Strongyloides
difficile stercoralis
ACUTE
GASTROENTERITIS
• Usually a self-limited illness, lasting 5-7 days, but
can cause life-threatening dehydration and
electrolyte imbalances

• Most commonly affected are children. Adults may be


infected after close contact with an infected infant,
but generally, the illness in adults is mild.

• Worldwide, most cases are due to viral with


rotaviruses and noroviruses being most common.
AGE annually affects 3-5 billion children and results
in 1.5-2.5 million deaths.
RISK FACTORS
• Ingestion of contaminated food and water
• Travel to high risk areas
• Compromised immune system
• Poor hygiene and lack of sanitation
PATHOPHYSIOLOGY
Ingestion of
infecting organism

Direct invasion of Enterotoxins are


the bowel wall produced

Stimulation and destruction of


mucosal lining of the bowel wall

Digestive and
absorptive malfunction
PATHOPHYSIOLOGY
Digestive and absorptive
malfunction

Fluid and electrolyte


imbalance

Watery diarrhea

Serious fluid volume


deficit / Dehydration
PATHOPHYSIOLOGY
Excessive gas
formation

GI Distention

Nausea and
Vomiting
TREATMENT
• Rehydration
• ~200 ml after each bout of diarrhea
• Rehydration drinks provide a good balance of water, salts,
and sugar.
• Medication
• Loperamide
• Paracetamol or ibuprofen
• Racecadotril
• Prochlorperazine, Promethazine, Ondansetron
• Ciproflaxin, Co-trimoxazole, Erythromycin/Azithromycin
• Metronidazole
THANK YOU
FOR
LISTENING! 
REFERENCES:
• http://reference.sabinet.co.za/webx/access/electronic_journals/m
p_sapa/mp_sapa_v12_n2_a13.pdf
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764079/
• http://link.springer.com/article/10.2165/00148581-200709030-
00006
• http://www.utmb.edu/pedi_ed/CORE/EmergencyPediatrics/page_
14.htm
• http://crisis.med.uoa.gr/tanzania2008/index_files/Gastroenteritis-
%20J.J.%20Kambona%20%5BCompatibility%20Mode%5D.pdf
• http://www.scribd.com/doc/50577556/Pathophysiology-of-Acute-
Gastroenteritis
• http://nursingcrib.com/nursing-notes-reviewer/medical-surgical-
nursing/acute-gastroenteritis-stomach-flu/

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