gastroenteritis%20-%20bacterial
GASTROENTERITIS - BACTERIAL
Diarrhea is a change in normal bowel movements characterized by increase in frequency, water content or volume of stools. The usual stool output is 10 g/kg/day.
Acute diarrhea lasts ≤14 days while chronic diarrhea lasts >14 days.
Infectious diarrhea is usually associated with symptoms of nausea and vomiting and abdominal cramps.

Diagnosis

  • Initial clinical evaluation of the patient with acute diarrhea should focus on assessment of the severity of the illness, the need for rehydration & the identification of likely causes on the basis of history & clinical findings
  • A careful clinical evaluation is needed in order to provide a cost-effective evidence-based approach to initial diagnostic tests & treatment
  • Management of acute diarrhea may be decided upon the history & presentation

Toxin-Induced Food Poisoning

  • Should be suspected in those with vomiting as the major presenting symptom

Bacterial Toxin-Induced Food Poisoning

  • Incubation period varies depending on causative agent
  • Diarrhea may follow vomiting & is usually not so severe
  • Abdominal pain may also be present & is usually colicky in nature
  • Most patients are afebrile & not severely dehydrated unless vomiting or diarrhea is intense

Traveler’s Diarrhea

  • Usually considered in a person who normally resides in an industrialized region & who travels to developing/ underdeveloped countries
  • May also refer to illness that occurs within 7-10 days after returning home
  • Patient often feels weak & with orthostatic symptoms

Assessment

Goals

  • To provide a starting point for treatment
  • To segregate which patients can safely be sent home for therapy, which ones should remain for observation during therapy & which ones immediately need intensive therapy

Dehydration Assessment 

Minimal or No Dehydration

  • Consists of <3% loss of body weight
  • Normal heart rate (HR), respiratory rate (RR) & pulse volume
  • Normal eyes with presence of tears, moist mucous membranes
  • Normal capillary refill
  • Normal to decreased urine output
  • Patient is well & alert

Mild to Moderate Dehydration

  • Consists of 3-9% loss of body weight
  • Normal to increased heart rate, respiratory rate
  • Normal to decreased pulse volume
  • Slightly sunken eyes with decreased tears, dry mucous membranes
  • Delayed capillary refill
  • Decreased urine output
  • Patient may appear normal, listless or fatigued

Severe Dehydration

  • Consists of >9% loss of body weight
  • Tachycardia with bradycardia especially in severe cases, deep respiration
  • Thready to absent pulse
  • Deeply sunken eyes with absence of tears, parched mucous membranes
  • Poor capillary refill
  • Minimal urine output
  • Patient may appear lethargic to comatose

History

  • Determine abrupt or gradual onset, duration & progression of symptoms
  • Onset & frequency of bowel movement
  • Amount of stool excreted
  • If dysenteric symptoms are present (eg fever, tenesmus, blood/pus in stool)

Physical Examination

  • Vital Signs
    • Orthostatic pulse, blood pressure (BP) changes, presence of fever
  • Other signs of volume depletion
    • Dry mucous membranes, decreased in skin turgor
  • Abdominal tenderness
  • Altered sensorium
  • Accurate body weight to estimate fluid loss

Laboratory Tests

  • The majority of patients presenting with acute gastroenteritis do not require laboratory tests
  • Consider complete blood count (CBC), blood culture, fecalysis, stool culture & sensitivity, electrolytes, blood urea nitrogen (BUN), creatinine & bicarbonate in patients with evidence of systemic illness, fever, bloody stools & moderate to severe dehydration
  • Stool Exam: Stools typical of cholera are typically greenish-yellow, clear, watery & with little food residue (rice-watery stools)
  • Stool Microscopy:
    • May reveal bacteria with darting motility
    • No white blood cell (WBC) or red blood cell (RBC)
  • Dark field microscopy (DFM) & Stool Culture/Sensitivity: Should be performed in both non-endemic & endemic areas
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