Gastroenteritis
Gastroenteritis: Excerpt from Professional Guide to Diseases (Eighth Edition)
A self-limiting disorder, gastroenteritis is characterized by diarrhea, nausea, vomiting, and acute or chronic abdominal cramping. Also called intestinal flu, traveler’s diarrhea, viral enteritis, or food poisoning, it occurs in persons of all ages and is a major cause of morbidity and mortality in underdeveloped nations. In the United States, gastroenteritis ranks second to the common cold as a leading cause of lost work time and fifth as the leading cause of death among young children. It also can be life-threatening in elderly or debilitated people.
Causes and incidence
Gastroenteritis has many possible causes, including:
❑ bacteria (responsible for acute food poisoning), such as Staphylococcus aureus, Salmonella, Shigella, Clostridium botulinum, C. perfringens, and Escherichia coli
❑ amebae, especially Entamoeba histolytica
❑ parasites, such as Ascaris, Enterobius, and Trichinella spiralis
❑ viruses (may be responsible for traveler’s diarrhea) such as adenoviruses, echoviruses, or coxsackieviruses
❑ ingestion of toxins, including plants or toadstools
❑ drug reactions; for example, to antibiotics
❑ enzyme deficiencies
❑ food allergens.
The bowel reacts to any of these enterotoxins with hypermotility, producing severe diarrhea and secondary depletion of intracellular fluid. Chronic gastroenteritis is usually the result of another GI disorder such as ulcerative colitis.
Diarrhea accounts for as many as 3% of pediatric office visits and 10% of hospitalizations for patients younger than age 5. Each year, gastroenteritis affects every adult and accounts for 8 million physician visits and 250,000 hospitalizations. Traveler’s diarrhea affects 20% to 25% of people traveling from industrialized countries to developing countries.
Signs and symptoms
Clinical manifestations vary depending on the pathologic organism and on the level of GI tract involved. However, gastroenteritis in adults is usually an acute, self-limiting, nonfatal disease producing diarrhea, abdominal discomfort (ranging from cramping to pain), nausea, and vomiting. Other possible signs and symptoms include fever, malaise, and borborygmi. In children, the elderly, and the debilitated, gastroenteritis produces the same symptoms, but these patients’intolerance to electrolyte and fluid losses leads to a higher mortality.
Diagnosis
Patient history can aid in the diagnosis of gastroenteritis. Stool culture (by direct rectal swab) or blood culture identifies the causative bacteria or parasites.
Treatment
Treatment is usually supportive and consists of bed rest, nutritional support, and increased fluid intake. When gastroenteritis is severe or affects a young child or an elderly or debilitated person, treatment may necessitate hospitalization, specific antimicrobials, I.V. fluid and electrolyte replacement and, possibly, antiemetics (given orally, I.M., or by rectal suppository).
Special considerations
Patient care includes education, administering medications, and assessing symptoms for signs of improvement or worsening.
❑ Administer medications as ordered; correlate dosages, routes, and times appropriately with the patient’s meals and activities (for example, give antiemetics 30 to 60 minutes before meals).
❑ If the patient can eat, replace lost fluids and electrolytes with broth, ginger ale, and lemonade, as tolerated. Vary the diet to make it more enjoyable, and allow some choice of foods. Warn the patient to avoid milk and milk products, which may provoke recurrence.
❑ Record intake and output carefully and obtain serial weight measurements. Watch for signs of dehydration, such as dry skin and mucous membranes, fever, and sunken eyes.
❑ Wash your hands thoroughly after giving care to avoid spreading infection.
❑ To ease anal irritation, provide warm sitz baths or apply witch hazel compresses.
❑ If food poisoning is the likely cause of gastroenteritis, contact public health authorities so they can interview patients and food handlers, and take samples of the suspected contaminated food.
❑ Teach good hygiene to prevent recurrence. Instruct patients to cook foods — especially pork — thoroughly; to refrigerate perishable foods, such as milk, mayonnaise, potato salad, and cream-filled pastry; to always wash hands with warm water and soap before handling food, especially after using the bathroom; to clean utensils thoroughly; to avoid drinking water or eating raw fruit or vegetables when visiting a foreign country; and to eliminate flies and roaches in the home.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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