What is gastroenteritis?

What is gastroenteritis?

Acute gastroenteritis is a common cause of morbidity and mortality worldwide. Conservative estimates put diarrhea in the top 5 causes of deaths worldwide, with most occurring in young children in non-industrialized countries. In industrialized countries, diarrheal diseases are a significant cause for morbidity across all age groups. Etiology includes bacteria, viruses, parasites, toxins, and drugs. Viruses are responsible for the majority of cases affecting patients of all ages. Viral gastroenteritis ranges from a self-limited watery diarrhea illness (usually less than one week) associated with symptoms of nausea, vomiting, anorexia, malaise, or fever to severe dehydration resulting in hospitalization or even death.

How does one know if one has gastroenteritis?

• The clinical spectrum of acute gastroenteritis ranges from asymptomatic infection to severe dehydration and death. Viral gastroenteritis typically presents with short prodrome with mild fever and vomiting, followed by 1-4 days of non-bloody, watery diarrhea. Viral gastroenteritis is usually self-limited.  
• The history should focus on severity and dehydration. The onset, frequency, quantity, and duration of diarrhea and vomiting are important factors in assessing the status. Oral intake, urination, and weight loss are important considerations. Viruses are the suspected cause of acute gastroenteritis when vomiting is prominent, when the incubation period is longer than 14 hours, and when the entire illness is over in less than 3 days. Travel history, eating history, and daycare history are important epidemiology factors.
• A viral cause should be suspected when the warning signs of bacterial infection (i.e., high fever, bloody
  diarrhea, severe abdominal pain, less than 6 stools / 24 hours) are absent and an alternative diagnosis is not suggested by epidemiologic clues from the history (e.g., travel, sexual practices, antibiotic use).  
• Ruling out other diagnoses is important, especially among the immune-compromised, neonatal and geriatric patients (ex. Sepsis can present as gastroenteritis)

Who are at risk/what are the risk factors?

• Acute gastroenteritis occurs throughout life. Severe cases are seen in very young and elderly. Etiology also
  varies with age but a viral etiology is the most common.
• Exposure to unsanitary conditions increases the risk.
• Proper hygiene should be overemphasized.

What happens when you have gastroenteritis?

• Spread from person to person occurs by fecal oral transmission of contaminated food and water causing
  irritations and inflammation of the gastrointestinal tract. 

How is gastroenteritis diagnosed? When / who do you consult?

• This can be diagnosed clinically, based on the history, signs and symptoms.  
• In most cases that fit the clinical features of viral gastroenteritis, lab tests are not indicated. If bacterial, amebic, or protozoal infection is suspected, stool studies for occult blood, WBC count, microscopy for protozoa, Clostridium difficile toxin, Giardia lamblia by enzyme immunoassay (EIA), or bacterial culture may be indicated.
• Consider investigating high fever, abdominal pain, and extreme dehydration by evaluating serum
  electrolytes, urea, creatinine, amylase, CBC count, and abdominal imaging studies.  
• If symptoms persist and if signs of dehydration appear, the patient should consult a physician (pediatrician, family physician, internist, or a gastroenterologist).

What are the available treatment options?

• Proper hygiene is still the first preventative step in viral gastroenteritis. Hand washing to prevent fecal oral
  transmission is very important. It also includes properly handling food and using clean water supplies.  
• Oral rehydration therapy is recommended for preventing and treating early dehydration and continued replacement therapy for ongoing loses.
• Replacing fluids and electrolytes, as directed by the estimated degree of dehydration, is the best treatment
  (whether out or in patient)  
• Antiemetics and antispasmodics may be given on as needed basis.
• Proper antibiotics should be started if infectious etiology is other than viral.  
• Those who cannot tolerate oral rehydration (Shock, severe dehydration, and decreased consciousness)
  require immediate confinement and intravenous therapy.  

What are the possible complications of gastroenteritis?

• Complications could range from electrolyte imbalance, to severe dehydration which could lead to acute renal failure, hypovolemic shock, or even death.

In TMC, what are the related services available?

• Internists and Gastroenterologists
• Routine stool exam and specialized tests such as occult blood, amoeba concentrate, Clostrodium difficile toxin, stool culture
• Endoscopic procedures (flexible sigmoidoscopy or colonoscopy) for chronic/recurrent diarrhea/ occult
  blood positive stool.

Note: This information is not intended to be used as a substitute for professional medical advise, diagnosis, or treatment. For any questions, please contact any of our accredited physicians.

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