Acute gastroenteritis: Difference between revisions
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===Causes=== | ===Causes=== | ||
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|+ Noninvasive AGE | |||
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! Species!! Onset !! Symptoms !! Transmisison !! Preformed Toxin | |||
|- | |||
| Viral || Example || Example || Example || No | |||
|- | |||
| [[S. aureus|Staph]]|| Example || Example || Example || Yes | |||
|- | |||
| [[Bacillus cereus|B. cereus]]|| Example || Example || Example || Yes | |||
|- | |||
| [[Clostridium (not difficile)|C. perfringens]]|| Example || Example || Example || Yes | |||
|- | |||
| [[Vibrio cholera|V. cholerae]]|| Example || Example || Example || No | |||
|- | |||
| [[Giardia]]|| Example || Example || Example || No | |||
|} | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
Revision as of 03:13, 31 October 2015
Background
- Blood diarrhea suggests bacterial etiology
- Viral AGE usually lasts <7d
- Do not dx isolated vomiting as AGE
Causes
| Species | Onset | Symptoms | Transmisison | Preformed Toxin |
|---|---|---|---|---|
| Viral | Example | Example | Example | No |
| Staph | Example | Example | Example | Yes |
| B. cereus | Example | Example | Example | Yes |
| C. perfringens | Example | Example | Example | Yes |
| V. cholerae | Example | Example | Example | No |
| Giardia | Example | Example | Example | No |
| Species | Onset | Symptoms | Transmission |
|---|---|---|---|
| Salmonella | 6-72 hours |
| |
| Shigella | 1-3 days |
|
|
| Yersinia | 1-5 days |
|
|
| Campylobacter | 1-7 days |
|
|
| C. Diff | 1-11 Weeks |
|
|
| Entamoeba | 1-11 weeks |
|
Clinical Features
- Vomiting/diarrhea
- Crampy/diffuse abdominal pain
Differential Diagnosis
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Diagnosis
- Assess hydration status
- Cap refill, skin turgor, resp rate
- Consider stool labs if:
- >10 stools in previous 24hr
- Travel to high-risk country
- Fever
- Bloody stool
- Persistent diarrhea
Treatment
- Oral rehydration therapy
- 30mL(1oz)/kg/hr
- Antiemetic
- Ondansetron 0.15mg/kg/dose IV/PO
- Antibiotics
- Only consider in pts w/ invasive infection
- Shigella, campylobacter, E. coli, yersinia, vibrio
- Bloody stool with mucus and fever
- NOT indicated for E. coli O157:H7
- NOT routinely indicated for salmonella
- Exceptions: SCD, IBD, <3mo
- Azithromycin (able to tolerate PO)
- Ceftriaxone (parenteral)
- Only consider in pts w/ invasive infection
