Acute gastroenteritis: Difference between revisions

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{{Adult top}} [[acute gastroenteritis (peds)]].''
==Background==
==Background==
*Blood diarrhea suggests bacterial etiology
*Blood diarrhea suggests bacterial etiology
*Viral AGE usually lasts <7d
*Viral AGE usually lasts <7d
*Do not dx isolated vomiting as AGE
*Do not diagnose isolated vomiting as AGE
==Diagnosis==
*Vomiting/diarrhea
*Crampy/diffuse abdominal pain


==Work-Up==
===Causes===
*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


==DDx==
{| class="wikitable"
|+ Noninvasive AGE
|-
! Species!! Onset !! Symptoms !! Transmission !! Preformed Toxin
|-
| [[viruses|Viral]] ([[norovirus]], [[adenovirus]], [[rotavirus]])
|| 11-72 hrs
||
*Nausea, vomiting, watery diarrhea
*Mild abdominal cramps, myalgia
||
*Fecal-oral
*Contaminated food or water
|| No
|-
| [[S. aureus|Staph]]
|| 1-6 hrs
||
*Nausea, severe vomiting, diarrhea,
*Mild abdominal cramping
||
*Previously cooked foods (mayonaise, ham, salads)
|| Yes
|-
| [[Bacillus cereus|B. cereus]]
|| 1-6 hrs
||
*Abrupt onset of nausea, vomiting, mild diarrhea
||
*Previously cooked foods (rice, vegetables, dried fruits, meat)
|| Yes
|-
| [[Clostridium (not difficile)|C. perfringens]]
|| 8-24 hrs
||
*Nausea, minimal vomiting, watery diarrhea
*Abd cramps
||
*Previously cooked or reheated meats and poultry
|| Yes
|-
| [[Vibrio cholera|V. cholerae]]|| 11-72 hrs ||
*Explosive rice-water diarrhea
*Vomiting, abdominal cramps
*Fever
||
*Fecal-oral
*Contaminated food or water
|| Yes
|-
| [[Giardia]]
|| 1-4 wks
||
*Flatus, bloating
*Foul-smelling and fatty stools (steatorrhea)
||
*Fecal-oral
*Contaminated water
|| No
|}


{| class="wikitable sortable"
{| class="wikitable sortable"
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! scope="col" | '''Transmission'''
! scope="col" | '''Transmission'''
|-
|-
| Salmonella||6-72 hours||
| [[Salmonella]]||6-72 hours||
*Fever
*[[Fever]], relative bradycardia
*Abd pain
*[[Abdominal pain]]
*Headache
*Bloody diarrhea
*[[Headache]]
*Osteomyelitis in sickle cell
||
||
*Eggs
*Eggs
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*Reptiles
*Reptiles
|-
|-
| Shigella||1-3 days||
| [[Shigella]]||1-3 days||
*Fever
*[[Fever]]
*abd pain
*[[Abdominal pain]]
*headache
*Bloody diarrhea
*[[Headache]]
*1-5 years old
*1-5 years old
*Seizures in children
||
||
*Food
*Food
*Fecal-Oral
*Fecal-Oral
|-
|-
| Yersinia||1-5 days||
| [[Yersinia]]||1-5 days||
*Appy Mimic, RLQ Pain
*[[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]]
*Abd pain
*[[Abdominal pain]]
*Kids and Young Adults
*Kids and Young Adults
*Guillain-Barre
||
||
*Water
*Water
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*Pets/Animals
*Pets/Animals
|-
|-
| C. Dif||10 days||
| [[C. Diff]]||1-11 Weeks||
*Copious FOUL diarrhea
*Copious FOUL diarrhea
||
||
*ABX use: PCN, Clinda, Cephalos
*Antibiotic use: [[PCN]], [[Clinda]], [[Cephalosporins]]
|-
|-
| Entamoeba||1-11 weeks||
| [[Entamoeba]]||1-11 weeks||
*Appy Mimic
*[[Appendicitis]] Mimic
*Abd, n/v/d
*[[Abdominal pain]], [[nausea/vomiting]], [[diarrhea]]
||
||
*Water
*Water
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|}
|}


==Treatment==
==Clinical Features==
#Oral rehydration therapy
*[[Vomiting]]/[[diarrhea]]
##30mL(1oz)/kg/hr
*Crampy/diffuse [[abdominal pain]]
 
==Differential Diagnosis==
{{Nausea and vomiting DDX}}
{{Abdominal Pain DDX Diffuse}}
 
==Evaluation==
*Assess hydration status
**Cap refill, skin turgor, respiratory rate
*Consider stool labs if:
**>10 stools in previous 24hr
**[[Traveler's diarrhea|Travel to high-risk country]]
**Fever
**Bloody stool
**Persistent diarrhea
**HIV / immunosuppressed
 
==Management==
#Rehydration (PO preferred)
#*30mL(1oz)/kg/hr
#Antiemetic
#Antiemetic
##Ondansetron 0.15mg/kg/dose IV/PO
#*[[Ondansetron]] 0.15mg/kg/dose IV/PO
#Antibiotics
 
##Only consider in pts w/ invasive infection
===[[Antibiotics]]===
###Shigella, campylobacter, E. coli, yersinia, vibrio
*''Only consider in patients with invasive infection''
###Bloody stool w/ mucus and fever
**[[Shigella]], [[campylobacter]], [[E. coli]], [[yersinia]], [[vibrio]]
##NOT indicated for E. coli O157:H7
**Bloody stool with mucus and fever
##NOT routinely indicated for salmonella
*NOT indicated for [[E. coli]] O157:H7
###Exceptions: SCD, IBD, <3mo
*NOT routinely indicated for salmonella
##Azithromycin (able to tolerate PO)
**Exceptions: SCD, [[IBD]], <3mo
##[[Ceftriaxone]] (parenteral)
*[[Azithromycin]] (able to tolerate PO)
*'''OR''' [[ciprofloxacin]]
*'''OR''' [[TMP-SMX]]
*[[Ceftriaxone]] (parenteral)


==Disposition==
==Disposition==
*Most can be discharged
===Admit===
*Unable to tolerate PO
*Hemodynamic instability
*Significant comorbidities


==See Also==
==See Also==
[[Nausea and Vomiting]]
*[[Nausea and vomiting]]
 
*[[Acute gastroenteritis (peds)]]
[[Diarrhea (Peds)]]
*[[Dehydration]]
 
*[[Acute diarrhea]]
[[Dehydration]]


==Source==
==References==
Tintinalli
<references/>


[[Category:GI]]
[[Category:GI]]
[[Category:Peds]]

Latest revision as of 20:34, 3 February 2020

This page is for adult patients. For pediatric patients, see: acute gastroenteritis (peds).

Background

  • Blood diarrhea suggests bacterial etiology
  • Viral AGE usually lasts <7d
  • Do not diagnose isolated vomiting as AGE

Causes

Noninvasive AGE
Species Onset Symptoms Transmission Preformed Toxin
Viral (norovirus, adenovirus, rotavirus) 11-72 hrs
  • Nausea, vomiting, watery diarrhea
  • Mild abdominal cramps, myalgia
  • Fecal-oral
  • Contaminated food or water
 No
Staph 1-6 hrs
  • Nausea, severe vomiting, diarrhea,
  • Mild abdominal cramping
  • Previously cooked foods (mayonaise, ham, salads)
 Yes
B. cereus 1-6 hrs
  • Abrupt onset of nausea, vomiting, mild diarrhea
  • Previously cooked foods (rice, vegetables, dried fruits, meat)
 Yes
C. perfringens 8-24 hrs
  • Nausea, minimal vomiting, watery diarrhea
  • Abd cramps
  • Previously cooked or reheated meats and poultry
 Yes
V. cholerae 11-72 hrs
  • Explosive rice-water diarrhea
  • Vomiting, abdominal cramps
  • Fever
  • Fecal-oral
  • Contaminated food or water
 Yes
Giardia 1-4 wks
  • Flatus, bloating
  • Foul-smelling and fatty stools (steatorrhea)
  • Fecal-oral
  • Contaminated water
 No
Invasive AGE
Species Onset Symptoms Transmission
Salmonella 6-72 hours
  • Eggs
  • Poultry
  • Water
  • Reptiles
Shigella 1-3 days
  • Food
  • Fecal-Oral
Yersinia 1-5 days
  • Water
  • Milk
  • Pork
  • Wild Animals
  • Fecal-Oral
Campylobacter 1-7 days
  • Water
  • Poultry
  • Pets/Animals
C. Diff 1-11 Weeks
  • Copious FOUL diarrhea
Entamoeba 1-11 weeks
  • Water
  • Sanitation
  • Travel

Clinical Features

Differential Diagnosis

Nausea and vomiting

Critical

Emergent

Nonemergent

Diffuse Abdominal pain

Evaluation

  • Assess hydration status
    • Cap refill, skin turgor, respiratory rate
  • Consider stool labs if:

Management

  1. Rehydration (PO preferred)
    • 30mL(1oz)/kg/hr
  2. Antiemetic

Antibiotics

Disposition

  • Most can be discharged

Admit

  • Unable to tolerate PO
  • Hemodynamic instability
  • Significant comorbidities

See Also

References

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