Acute gastroenteritis: Difference between revisions
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*Viral AGE usually lasts <7d | *Viral AGE usually lasts <7d | ||
*Do not dx isolated vomiting as AGE | *Do not dx isolated vomiting as AGE | ||
== | ===Causes=== | ||
*Viral | *Viral | ||
*Non-Invasive | *Non-Invasive | ||
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! scope="col" | '''Transmission''' | ! scope="col" | '''Transmission''' | ||
|- | |- | ||
| Salmonella||6-72 hours|| | | [[Salmonella]]||6-72 hours|| | ||
*Fever | *[[Fever]] | ||
* | *[[Abdominal pain]] | ||
*Headache | *[[Headache]] | ||
|| | || | ||
*Eggs | *Eggs | ||
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*Reptiles | *Reptiles | ||
|- | |- | ||
| Shigella||1-3 days|| | | [[Shigella]]||1-3 days|| | ||
*Fever | *[[Fever]] | ||
* | *[[Abdominal pain]] | ||
* | *[[Headache]] | ||
*1-5 years old | *1-5 years old | ||
|| | || | ||
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*Fecal-Oral | *Fecal-Oral | ||
|- | |- | ||
| Yersinia||1-5 days|| | | [[Yersinia]]||1-5 days|| | ||
* | *[[Appendicitis]] mimic, [[RLQ Pain]] | ||
*Fever | *[[Fever]] | ||
*Vomiting | *[[Vomiting]] | ||
*Kids and Young Adults | *Kids and Young Adults | ||
|| | || | ||
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*Fecal-Oral | *Fecal-Oral | ||
|- | |- | ||
| Campylobacter||1-7 days|| | | [[Campylobacter]]||1-7 days|| | ||
*Low grade fever | *Low grade [[fever]] | ||
* | *[[Abdominal pain]] | ||
*Kids and Young Adults | *Kids and Young Adults | ||
|| | || | ||
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*Pets/Animals | *Pets/Animals | ||
|- | |- | ||
| C. Dif||1-11 Weeks|| | | [[C. Dif]]||1-11 Weeks|| | ||
*Copious FOUL diarrhea | *Copious FOUL diarrhea | ||
|| | || | ||
* | *Antibiotic use: [[PCN]], [[Clinda]], [[Cephalosporins]] | ||
|- | |- | ||
| Entamoeba||1-11 weeks|| | | [[Entamoeba]]||1-11 weeks|| | ||
* | *[[Appendicitis]] Mimic | ||
* | *[[Abdominal pain]], [[nausea/vomiting]], [[diarrhea]] | ||
|| | || | ||
*Water | *Water | ||
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*Travel | *Travel | ||
|} | |} | ||
==Clinical Features== | |||
*[[Vomiting/diarrhea]] | |||
*Crampy/diffuse [[abdominal pain]] | |||
==Differential Diagnosis== | |||
{{Abdominal Pain DDX Diffuse}} | |||
==Diagnosis== | |||
*Assess hydration status | |||
**Cap refill, skin turgor, resp rate | |||
*Consider stool labs if: | |||
**>10 stools in previous 24hr | |||
**[[Traveler's diarrhea|Travel to high-risk country]] | |||
**Fever | |||
**Bloody stool | |||
**Persistent diarrhea | |||
==Treatment== | ==Treatment== | ||
#Oral rehydration therapy | #Oral rehydration therapy | ||
# | #*30mL(1oz)/kg/hr | ||
#Antiemetic | #Antiemetic | ||
# | #*[[Ondansetron]] 0.15mg/kg/dose IV/PO | ||
#Antibiotics | #[[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) | ##[[Ceftriaxone]] (parenteral) | ||
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==See Also== | ==See Also== | ||
[[Nausea and Vomiting]] | *[[Nausea and Vomiting]] | ||
*[[Diarrhea (Peds)]] | |||
[[Diarrhea (Peds)]] | *[[Dehydration]] | ||
[[Dehydration]] | |||
== | ==References== | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 14:35, 1 July 2015
Background
- Blood diarrhea suggests bacterial etiology
- Viral AGE usually lasts <7d
- Do not dx isolated vomiting as AGE
Causes
- Viral
- Non-Invasive
- Invasive
| Species | Onset | Symptoms | Transmission |
|---|---|---|---|
| Salmonella | 6-72 hours |
| |
| Shigella | 1-3 days |
|
|
| Yersinia | 1-5 days |
|
|
| Campylobacter | 1-7 days |
|
|
| C. Dif | 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