Gastroenteritis has many causes: bacterial , viral and parasitic . Of these, the most commonly encountered in medical practice are the viral (especially in children) and the bacterial .
It is very important that when the patient experiences diarrhea accompanied by nausea and vomiting and impaired general condition , gastroenteritis is diagnosed by exclusion preference because there are a number of systemic infections (such as pneumonia, meningitis, sepsis or infection tract urine ) that may have similar complaints .
Infectious agents may have exogenous origin ( in the environment ) or can be of endogenous origin . In certain conditions , the bacteria in the digestive tract ( which normally have beneficial ) can proliferate very much and gets even pathogenicity characters , making them determine normal bowel alterations . Such a situation can occur if the patient is being treated with antacids or inhibit gastric secretion . It is known that stomach acid is an important factor that limits you in bacterial multiplication . Whenever it is reduced (eg , in the treatment of reflux oesophagitis , peptic ulcer ) , the entire digestive system suffers.
Both viruses , and especially bacteria are very contagious and can spread easily through contaminated food , the transmission is favored by poor hygiene. In addition , the patient once infected, can autoinfecta , perpetuating the disease, if it has a rigorous hygiene , which includes washing hands thoroughly before each meal and after using the toilet . Washing hands is usually trivial, that you basic hygiene , but it is very important . Unfortunately , it is sometimes overlooked , especially by children. In the majority of cases ( up to 70 % ) , gastroenteritis viruses are due to enteric infections . Rotaviruses , caliciviruses , adenoviruses , Norwalk virus , coronaviruses and astrovirusurile are just a few of the commonly incriminated . Viral gastroenteritis resolve in 2-3 days without requiring specialist treatment if the patient is stable.
Rotaviruses are the leading cause of pediatric gastroenteritis . It seems that aproximtiv 30-40% of children diagnosed gastroenteritis viral nature . Rotavirus infection is particularly dangerous in children because it can cause a very severe diarrhea , the health of the patient destabilizandu rapidly . Dehydration occurs on this background is mainly in children , life-threatening . Viral gastroenteritis will not respond to treatment with antibiotics , so this should be avoided completely. Parents are advised to submit the child to a specialist and does not administer antibiotics at home. These are drugs directed exclusively against bacteria, they have no effect against viruses . In addition, given the chaotic , further disrupt the intestinal bacterial flora , thereby worsening general and intensify symptoms.
Bacterial gastroenteritis represents approximately 20% of all those diagnosed , and most times the bacteria involved are Salmonella , Shigellosis , yersiniosis , Clostridium difficile , Campylobacter and E. coli ( enterotoxigenic its subtypes , enteroaderent , enteroinvaziv , enterohaemorrhagic ) .
One . Escherichia coli incriminated in traveler's diarrhea and dysentery in many colitis and uremic syndromes .
Two . Salmonella is the etiologic agent of typhoid fever , and can easily be passed from animals, whether by manipulating individual does not wash their hands properly .
Three . Campylobacter can be transmitted through inadequately cooked milk ( unpasteurized ) and the raw meat or " blood " .
April . Shigella is incriminated in causing dysentery . Bacterial gastroenteritis are dangerous because they have a longer duration and often require specific treatment . They can endanger health by acute dehydration that favors the body as a direct result of electrolyte loss through diarrhea.
Parasitic gastroenteritis are rare compared to viral and bacterial infections , but their presence should not be neglected . Giardia , Cryptosporidium parvum and Cyclospora are most often cited . They pose problems , especially in immunocompromised patients ( Cryptosporidium ) and children . 10% of the etiology of gastroenteritis and often pass only after administration of appropriate treatment . Way of contamination is in these cases digestive parasite can be ingested with food or water unhealthy . Swimming in contaminated pools can be a common way of transmission.
Other relatively common causes encountered noninfectious include:
- Contanimarea with exogenous toxins , food allergens , heavy metals . Most often heavy metals can contaminate drinking water.
- Poisoning of seafood toxins .
- Ingestion of drugs that can cause side effect gastroenteritis : NSAIDs, aspirin , antibiotics , laxatives , hormones, steroids, colchicine , cholinergic agents , sorbitol, quinidine .
- Excessive consumption of coffee and caffeine based products .
- Lactose intolerance .
- Pseudomembranous colitis .
- Side effects of radiotherapy or chemotherapy.
- Carcinoid tumors .
- Crohn's disease .
- Ischemic colitis , ulcerative colitis.
Very many causes still remain unidentified , especially in underdeveloped countries . Afectiunele heal spontaneously but etiologic agent is not determined .
SimptomatologieSus
Gastroenteritis can affect the stomach and intestine in varying degrees.
The most common complaint of patients with acute disease such as:
- Moderate fever
- Nausea with or without vomiting
- Anorexia
- Headache
- Diarrhoea moderate intensity : between 2-4 stools per day .
- Bloating accompanied by intense abdominal cramps .
- Flatulence .
- Vomiting : Not in all cases , and not necessarily accompany diarrhea. But if present, gastroenteritis is more serious , such as dehydration may increase much faster .
Symptoms of worsening of general condition include:
- Hematemesis ( vomiting)
- Haematochezia
- Prolonged vomiting more than 48 hours
- High fever
- Intense abdominal pain localized mainly on the right abdominal flank
- Oliguria ( reduced urination numeric and quantitative) , sensation of dry skin , the appearance of mucosal dryness , excessive thirst (these are warning signs that indicate the installation of a state of acute dehydration )
- Alteration of consciousness
- Lethargy
Note !
Dehydration in infants is manifested by depression fontanelle , by withdrawing the eyes in their sockets , the appearance of dark circles by reducing urination and altering consistency and skin coloration . Any sign suggestive of a state of emergency requires disclosure inadequate hydration pediatrician or the emergency room of a hospital , that baby immediately receive the treatment they need.
Consulting a specialistSus
Gastroenteritis is a self-limiting disorder character . This is not the rule. There are certain risk categories , but there are situations in which the etiologic agent is so aggressive that it can overcome even the defense barrier integrity . Any malaise , characterized by nausea, vomiting and diarrhea that lasts more than a day ( for adults ) must be investigated . These symptoms present in children , elderly and immunocompromised require presentation to hospital , any delay worsening of general conditions favoring .
If feeding and hydration are not possible at home ( for various reasons , including because there is a food intolerance in general ) should be provided to CAMERADATA guard . In such cases the patient is required parenteral rehydration achieved by infusion .
Emergency physician should want if you experience:
- Changing consciousness
- Blood in the stool (diarrhea with mucus and blood ) or vomiting fluid
- Vomiting that extend for a longer period than 48 hours
- Bloating painful
- Signs suggestive of dehydration.
Investigations paracliniceSus
Persistent diarrhea and vomiting are symptoms suggestive of a gastroenteritis , but they can occur in other diseases. Their cause should always be investigated properly . Investigation of patients with suspected gastroenteritis should start with history , within its physician can learn some very important information . It can determine whether acute or chronic symptoms character , if any risk factors for bacterial infections (such as trips to exotic countries ) , if the patient was under antibiotic treatment ( or other drugs that may encourage or induce such a condition ) . If the symptoms are lasting longer, for weeks , they are suggestive rather a chronic inflammatory condition or a disorder of the immune system . Sudden onset , in the absence of known risk factors may indicate a change unhealthy diet or administration may occur amid a new medication .
It is very important that prior to presentation to the doctor , the patient can describe some features of seats , particularly their frequency and appearance. Your doctor may ask if there is mucus and blood in the stool , or if they are just watery , since such information can guide the etiological diagnosis . Of course, samples will be collected and chairs, but if the patient can provide such information , they always prove useful . Other useful information that can be specified on diarrheal stools are if the amount reduced or increased if they have a high fat content ( whether floating or have an oily ) . Also , please note if during this period , signs of dehydration, if the patient could eat normally in this time or if the symptoms were so severe that they restricted diet .
This foot is also a factor to be known . If the patient had fever or chills , they suggest marrow invasion and at least bacteremia , if the state was not already complicated with sepsis .
History will be completed with questions about personal and family history , it is important to determine if such symptoms occurred and other family members are registered or isolated , and if they were repeated in the past ( and have recurrent ) .
Note !
It is very important that patients with symptoms suggestive of a gastroenteritis to their doctor if they have recently traveled in developing countries or in exotic countries , if they swam in pools (possibly contaminated ) if they drank unfiltered water (eg rivers mountain ) , or if they made major changes in diet or nutrition . Any change to the way in which cooked food can be incriminated in diarrhea and vomiting . Bacterial contaminated foods cause symptoms of gastroenteritis after a variable period , depending on each pathogen separately. For example , Salmonella contamination occurs after 12-72 hours , the Clostridium After 8-10 hours , the one with Staphylococcus aureus ( less common etiologic agent ) for 3-6 hours .
Physical examination is a very important step that can be performed concurrently or consecutively anamnesis . Must be very thorough examination to detect signs of dehydration time , and other effects of the disease. The physical examination should be excluded and other causes of diarrhea, the differential diagnosis is done in the presence of these symptoms, : toxic megacolon , appendicitis , pancreatitis , cholecystitis acute hemolytic uremic syndrome .
The most important element of the physical exam is to determine hydration status . Signs of dehydration are adults : dry membranes , tachycardia , hypotension , altered mental status objective , oliguria . Assessment of dehydration in young children is through observation seat and urination ( dry diaper often ) by the disappearance tears through a change ( downward ) capillary bed refill time ( recolor of skin ) by depression prior fontanelle .
Examination of the abdomen should be done very carefully because it is often very sensitive, sensitivity is generalized . It is very important to determine whether it is an acute surgical abdomen , if there borborigme ( noise intestinal peristalsis suggests that is still preserved ) , if any abdominal masses ( abscesses) or organomegaly . Other diseases with similar symptoms to be excluded , so that no errors of treatment include acute appendicitis , acute pancreatitis , intestinal obstruction , pseudomembranous colitis and carcinoid tumors .
Specialized laboratory investigations in such situations include the following :
One . Microbiological analysis of the seat ( making coprocultures ) to determine possible etiopatiogenic agent involved
In this test can also determine whether or not leukocytes in the stool , their presence indicating the nature of inflammatory diarrhea . Approximately 90 % of patients infected with Salmonella and Shigella appear leukocytes in the stool . Such an investigation is useful only if it is suspected from the beginning a bacterial infection . Stool cultures should be performed if the patient has fever, bloody or mucous- bloody stools . Coprologic routine examinations are only able to determine infection with Salmonella , Shigella , Campylobacter and Yersinia . If you suspect other bacteria ( Vibrio cholerae species , E. coli ) will make special media culture . These methods are more expensive , however , and the results are more reliable .
Two . General Investigation Laboratory include assessment of renal function , liver , blood count and electrolytes analysis
These tests are only useful in assessing disease severity and patient's assessment of dehydration status , they can not determine the etiology of gastroenteritis . In patients with dehydration is recommended to determine the level of urea and creatinine for determining whether hyponatremia or hypernatremia installed .
Imaging investigations are recommended only if suspected bowel obstruction , toxic megacolon or intestinal perforation . Otherwise , they are not helpful and their achievement is not recommended.
Sigmoidoscopy is also an investigation in which only calls the special conditions , if there are signs indicating a possible inflammatory or pseudomembranous colitis .
Treatments
The goals of treatment of patients with gastroenteritis are mainly avoiding the installation of state of dehydration, addressing key symptoms (especially pain, fever) , identifying and treating complications . Assessment of hydration status is still at presentation to the emergency room , during anamnesis .
Implementation of measures to prevent dehydration installation can be taken by the patient at home , so to go to the emergency room .
Home Treatment
The most important recommendation in this situation is eating plenty of fluids . Since dehydration has many systemic consequences , it is important to bring body fluids consumed and part of the electrolytes that are lost through diarrhea and vomiting. Therefore , drinking water , water is the best fluid for rehydration , because its content is very low in electrolytes . For the same reason , and to avoid carbonated drinks , the caffeine based teas . Irritable bowel is able to absorb water properly , and in addition , it may further dilute electrolytes rest. Such complications can arise important electrolyte and even seizures .
Rehydration solutions must be done with children specifically designed to serve this purpose, which can be found in pharmacies and that adequate proportion of electrolytes. After each seat , children younger than 2 years should receive 100 ml of rehydration solution , and children older than 2 years can receive up to 250 ml of rehydration solution . Adults should drink plenty of fluids rehydration as mature organism needs are more complex .
These recommendations replace only losses diarrhea. Because hydration status to remain in optimal patients need to consume additional amounts of liquid .
If rehydration fluids are not available , experts have come up with a recipe for preparing mixtures can replace electrolyte losses . They contain 2 tablespoons of sugar ( or honey ) 1/4 teaspoon of salt, 1/4 teaspoon of baking soda. They add to a liter of water that was previously boiled and cooled . Such a mixture can prevent electrolyte disorders , but the patient must be present at the hospital for his health then be properly evaluated and treatment to be more readily established .
Even though it may be more difficult , patients should try to consume and solid food. Experts insist that after 24 hours of liquid nourishment menu be made of bananas , rice, applesauce (or applesauce, but no sugar ) , toast , pasta and tomatoes.
Specially designed children 's menu and it should situ only by your pediatrician . Small children should not receive ORS as tea, water or juice . In such situations there is a risk of inducing seizures hyponatremia. This infant must be submitted as soon as the doctor . In these cases the etiological treatment is very important . Subsequently the patient will receive a special diet consisting mainly of rice water , carrot soup , carob powder . Even in the present administration of fluids for rehydration , the child's condition can deteriorate rapidly. Presentation to the doctor becomes an emergency .
For adults dehydration can occur late as compared to children . The body in these situations a book much larger and can handle certain critical situations . But if no action is taken promptly , even the most resistant body will feel . The often severe complications and dehydration occur amid chronic conditions such as chronic kidney disease or diabetes.
Rehydration adults can be made with fruit juices , fluids and nelactozate necafeinizate . You can drink commercially available, whose purpose is rehydration and electrolyte rebalancing . After 24 hours the liquid diet , and after vomiting has stopped , it can set solid and semi-solid food diet , which may include the same principles food : carrots , rice , bananas , tomatoes , pasta and toast .
Patients should consult a physician of infectious disease , especially if the diarrhea is chronic , antibiotic treatment if there is substantive or if there are other concomitant infectious diseases (especially HIV infection ) .
Treatment specialitateSus
Experts recommend that patients presenting to the emergency room trying to rehydrate orally. If this is not an option (due to recurrent vomiting ) , the hospital will be rehydrate intravenously. In severe cases , the team of specialists who will take care of the patient may be more complex , including a gstroenterolog , toxicologist or general surgeon .
If the patient is unstable, therapeutic measures to be taken can be quite aggressive , rebalancing the body should be done as quickly .
Drug treatment aims to reduce intestinal motility , prevent complications and , if possible, to reduce the duration of the disease evolution . Recently was aprobabt and began to be used a rotavirus vaccine , for children . Take three boosters , from the age of 6-12 weeks of age and ending at 32 weeks .
Antiobiotic treatment is for cases of bacterial infectious gastroenteritis . These are the worst , and have a longer evolution . In addition, specific antibiotics may act only against bacteria . Treatment is not until after the etiologic diagnosis is established with certainty and wine and sensitivity testing . DST is an investigation after determining that antibioitice is sensitive bacteria incriminated in causing disease. If not use inappropriate antibiotics , there is a risk that the condition to worsen , and the intestinal flora to be extra aggressive.
Antibiotics chosen should cover a large range of germs ( to have broad spectrum ) . These include:
- Ciprofloxacin : recommended especially diarrhea Salmonella , Campylobacter , E. coli, Shigella and Yersinia .
- Trimethoprim - sulfamethoxazole : is used in patients age 18 and over , especially when it comes to diarrhea caused by Campylobacter .
- Vancomycin : is for treatment of Clostridium difficile diarrhea .
Antiemetic treatment is designed to reduce nausea and vomiting . It can have some side effects , especially if the patient is severely dehydrated. It should be taken very cautiously and only under medical supervision . The doses selected must be the least active , and often why such treatment is not recommended for children . Antiemetics included in current schemes include promethazine , prochlorperazine and ondansetron . Sometimes such drugs may also be administered in the form of suppositories , if the patient can not take orally.
Antidiarrheal agents Administration aims to reduce the number of seats and grow their consistency . Not recommended in patients with dysentery, and diarrhea should be administered only if not generated by toxigenic mechanism . Antidiarrheal agents currently used include Imodium ( loperamide ) , atropine sulfate .
Further treatment after initial stabilization of patients includes managing complications (both toxic and nontoxic ) , and of sepsis . Patients should be advised that after such a condition , it is possible that refueling is not as easy . There can be certain food intolerances , why not recommend a varied diet , and in any case a diet abundant. Foods should be reintroduced moderate gradually and as the body reobisnuieste them , the diet may be becoming more varied.
PrevenireSus
The most important recommendations to prevent pathogen infection are gastroenteritis been responsible for the appearance of respect for basic hygiene . Experts advise us to wash our hands often , especially after using the toilet , after handling money by using public transportation. It is also very important and the foods they eat to be stored in hygienic areas and temperatures preventing them from degradation and bacterial contamination .
Other tips include:
- Beblusilor laundry at high temperatures to destroy germs .
- Vaccination against rotavirus , Salmonella and Vibio against cholera .
- Avoid traveling in developing countries developmental points or avoid eating tap water if we are in such countries.
- Compliance with diets where there is lactose intolerance.
- Avoid seafood , especially by patients with state of immunosuppression.
- Avoiding bottled water . Water from rivers , lakes , no matter how clean it may seem, is often highly infested .
Complications
The most common complications associated gastroenteritis include:
- Dehydration ;
- Malabsorption ;
- Transient intolerance to lactose ;
- Chronic diarrhea ;
- Disseminated systemic infections ( meningitis , pneumonia , arthritis ) , especially Salmonella ;
- Haemolytic uraemic syndrome ;
- Toxic megacolon .
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