أبو أحـمد
03-26-2007, 10:21 PM
Gastroenteritis
Gastroenteritis refers to an inflammation of the intestinal tract that occurs
most commonly from a viral infection of the intestines. A number of conditions
that are closely related will be discussed in this section. They are all forms
of gastroenteritis, but are caused by different infectious agents.
1. Viral Gastroenteritis:
The most common form of gastroenteritis. Examples
include Enterovirus and Rotavirus.
2. Traveler's Diarrhea (often caused by bacteria in food or
water).
3. Food Poisoning (secondary to the consumption of bacteria or their toxic
byproducts)
4. Antibiotic induced enteritis (seen after antibiotic use in some patients)
5. Parasitic infection (Giardia)
Common symptoms of all the above
include: cramps, diffuse abdominal pain,
nausea, vomiting, and diarrhea in most cases. Fever and chills can accompany all
types of gastroenteritis, but are usually present in only the viral and
bacterial causes. If dehydration results, the patient will feel weak,
lightheaded, or faint upon standing.
Patients who are victims of food poisoning usually have onset of symptoms 2-6
hours after eating the contaminated meal. Some of the more persistent forms of
bacterial gastroenteritis (e.g. Salmonella) can result in weight loss.
Evaluation
will include history (for foreign travel or antibiotic use prior to
onset of symptoms) and physical examination. There should be NO well-localized
abdominal tenderness to palpation. The abdomen should be soft and not rigid.
Blood tests (i.e. blood counts, amylase, blood chemistry, and liver profile)
will be done to exclude other causes for the symptoms, and to screen for
dehydration or electrolyte imbalance (salt depletion). A stool specimen may be
sent for culture in cases of suspected bacterial intestinal infections.
Treatment
in all cases requires restriction to a clear liquid diet. Juices,
water, Jello, or (Gatorade) work well to restore the body's fluid and salt
requirements. Acetaminophen for fever control every 4 hours is recommended.
Those patients thought to be suffering from antibiotic induced gastroenteritis
must stop taking the offending antibiotic (your doctor will determine if a
substitute antibiotic is necessary). Those patients with food poisoning are
usually much better within 24-36 hours with only a clear liquid and general
supportive care. Those thought to have bacterial gastroenteritis or traveler's
diarrhea may benefit from treatment with an antibiotic (Cipro or Bactrim)
pending stool culture results.
Some bacterial forms, such as Salmonella, Campylobacter, or Shigella, will be
treated with antibiotics, and will be resolved over longer period of time (1-2
weeks). Suspected viral gastroenteritis (majority of cases) should not be
treated with antibiotics, unless the results from the stool culture determine
otherwise.
Antidiarrheal agents (Imodium, Lomotil) may be used if diarrhea is profuse.
Patients should drink plenty of fluids and have plenty of bed rest. Close
observation for the signs and symptoms of dehydration
Those patients unable to retain fluids secondary to intractable vomiting will
require admission to the hospital. The elderly patient, the diabetic on
insulin, or the patient with an electrolyte imbalance will require admission for
IV fluid administration.
Gastroenteritis refers to an inflammation of the intestinal tract that occurs
most commonly from a viral infection of the intestines. A number of conditions
that are closely related will be discussed in this section. They are all forms
of gastroenteritis, but are caused by different infectious agents.
1. Viral Gastroenteritis:
The most common form of gastroenteritis. Examples
include Enterovirus and Rotavirus.
2. Traveler's Diarrhea (often caused by bacteria in food or
water).
3. Food Poisoning (secondary to the consumption of bacteria or their toxic
byproducts)
4. Antibiotic induced enteritis (seen after antibiotic use in some patients)
5. Parasitic infection (Giardia)
Common symptoms of all the above
include: cramps, diffuse abdominal pain,
nausea, vomiting, and diarrhea in most cases. Fever and chills can accompany all
types of gastroenteritis, but are usually present in only the viral and
bacterial causes. If dehydration results, the patient will feel weak,
lightheaded, or faint upon standing.
Patients who are victims of food poisoning usually have onset of symptoms 2-6
hours after eating the contaminated meal. Some of the more persistent forms of
bacterial gastroenteritis (e.g. Salmonella) can result in weight loss.
Evaluation
will include history (for foreign travel or antibiotic use prior to
onset of symptoms) and physical examination. There should be NO well-localized
abdominal tenderness to palpation. The abdomen should be soft and not rigid.
Blood tests (i.e. blood counts, amylase, blood chemistry, and liver profile)
will be done to exclude other causes for the symptoms, and to screen for
dehydration or electrolyte imbalance (salt depletion). A stool specimen may be
sent for culture in cases of suspected bacterial intestinal infections.
Treatment
in all cases requires restriction to a clear liquid diet. Juices,
water, Jello, or (Gatorade) work well to restore the body's fluid and salt
requirements. Acetaminophen for fever control every 4 hours is recommended.
Those patients thought to be suffering from antibiotic induced gastroenteritis
must stop taking the offending antibiotic (your doctor will determine if a
substitute antibiotic is necessary). Those patients with food poisoning are
usually much better within 24-36 hours with only a clear liquid and general
supportive care. Those thought to have bacterial gastroenteritis or traveler's
diarrhea may benefit from treatment with an antibiotic (Cipro or Bactrim)
pending stool culture results.
Some bacterial forms, such as Salmonella, Campylobacter, or Shigella, will be
treated with antibiotics, and will be resolved over longer period of time (1-2
weeks). Suspected viral gastroenteritis (majority of cases) should not be
treated with antibiotics, unless the results from the stool culture determine
otherwise.
Antidiarrheal agents (Imodium, Lomotil) may be used if diarrhea is profuse.
Patients should drink plenty of fluids and have plenty of bed rest. Close
observation for the signs and symptoms of dehydration
Those patients unable to retain fluids secondary to intractable vomiting will
require admission to the hospital. The elderly patient, the diabetic on
insulin, or the patient with an electrolyte imbalance will require admission for
IV fluid administration.