Gastroenteritis
Inflammation of Stomach and intestines resulting in diarrhea,
vomiting and abdominal cramps.
History: Contracting the infectious agent 12 to 72 hours
before the complain.
Symptoms and signs:
1- Diarrhea.
2- Vomiting.
3- Abdominal cramps.
4- Fever.
5- Fatigue.
6- Headache.
7- Muscle pain.
8- Bloody stool.
9- Dehydration.
10 – Poor skin elasticity.
11 – Arthritis.
Causative organisms:
A – Viruses:
1 – Rotavirus.
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2 – Norovirus.
3 – Adenovirus.
4 – Astrovirus.
B – Bacteria:
1 – Campylobacter jejuni.
2 - Salmonella.
3 – Shigella.
4 – Escherichia coli.
5 – Clostridium dificile.
6 – Vibrio cholera.
7 – Vibrio el-tor.
C – Protozoa:
1 – Giardia lambia.
2 – Entamoeba histolytica.
3 – Cryptosporidium.
Transmission:
1 – Cntaminated water with sewage.
2 – Contaminated cooked food( from food handlers).
3 – Uncooked food:
a – Vegetables fertilized with human excreta.
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b – Poultry and eggs( Salmonella enteritidis).
c – Fish and snails.
d – Water or food contaminated with rat excreta.
e - Water or food contaminated with different animal excreta
( Giardia).
f – Mechanical transmission by insects or animals.
Diagnosis:
1- Mainly through symptoms and signs.
2- Stool culture in bloody diarrhea.
Differential diagnosis:
1 – Appendicitis.
2 – Volvulus.
3 – Irritable bowel syndrome.
4 – Urinary tract infection.
5 – Abuse of drugs or herbes( induce laxation).
Prevention:
1 – Supply with fresh clean water.
2 – Good hygiene.
3 – Hand washing.
4 – Breast feeding.
5 – Food freezing( Meat, fish, etc).
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6 – Avoid contaminated food or drink.
7 – Vaccination with rotavirus vaccine.
8 - Vaccination with cholera vaccine( 60 % effectiveness).
Management:
1 – Many cases are acute self limited diseases does not require
medication.
2 – Oral rehydration with all kinds of fluids and the best is fresh
fruits juice to correct electrolyte imbalance.
3 – Intravenous rehydration( infants and cholera).
4 – Natural antipyretics( fever): bathing is much better than
putting cold dressing on head and extremities.
5 – Medical antipyretic as acetyl salicylic acid.
5 – Diet must not be stooped. Cooked rice and vegetable soap
are recommended.
6 – Probiotics ( lactobacillus acidophilus sps.) to colonized in
the intestines.
7 – Antiemetics (suprarenal gland product).
8 – Antibiotics:
a – Sulfa Guanidine.
b – Streptomycin.
c – Vancomycin.
d – Azithromycin.
e – Macroloide.
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f – Fluoroquinolones.
9 – Mitronidazole to treat Entameba and anaerobic infections.
10 – Antimotility agents: cause complications and we advice to
not use.
Case no 1:
A child 2 years old with Coma, Pallor , unrefrectable and
feverish. his mother told us that he have diarrhea and vomiting
since 2 days. when we examine we found that the temperature is
40.2 °C and the skin is unelastic, the eyes were depressed and
the tongue was dried.
A- What are the investigations you need to diagnose the
case?
B- What is the diagnosis?
C- What is the differential diagnosis?
D- What is the causes?
E- What is the plan for management?
F- What is the treatment in details?
G- What is the mistakes may be done by the medical staff
can lead to delayed healing?
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Case no 2:
A man 50 years complain from diarrhea,abdominal cramp and
odourless flatus. when we asked him we find that he is working
a teacher, have work trouble, married and family is out country.
when we examine we found that he have the signs of depression
and his abdomen is distended.
A- What are the investigations you need to diagnose the
case?
B- What is the diagnosis?
C- What is the differential diagnosis?
D- What is the causes?
E- What is the plan for management?
F- What is the treatment in details?
G- What is the mistakes may be done by the medical staff
can lead to delayed healing?
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Case no. 3:
A university student 22 yearscomplain from diarrhea 10
times/day. When we asked told us that he is from damam,
living alone at Zulfi and eat his 3 meals in the cheap
restaurants at the town. when examined we find the blood
pressure 130/80, pulse 75/min ,systolic murmur, pallor and
temperature 39°C.
A- What are the investigations you need to diagnose the
case?
B- What is the diagnosis?
C- What is the differential diagnosis?
D- What is the causes?
E- What is the plan for management?
F- What is the treatment in details?
G- What is the mistakes may be done by the medical staff
can lead to delayed healing?
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