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 | *Do not diagnose isolated vomiting as AGE | ||
== | ===Causes=== | ||
{| 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" | |||
|+ Invasive AGE | |||
|- | |||
! scope="col" | '''Species''' | |||
! scope="col" | '''Onset''' | |||
! scope="col" | '''Symptoms''' | |||
! scope="col" | '''Transmission''' | |||
|- | |||
| [[Salmonella]]||6-72 hours|| | |||
*[[Fever]], relative bradycardia | |||
*[[Abdominal pain]] | |||
*Bloody diarrhea | |||
*[[Headache]] | |||
*Osteomyelitis in sickle cell | |||
|| | |||
*Eggs | |||
*Poultry | |||
*Water | |||
*Reptiles | |||
|- | |||
| [[Shigella]]||1-3 days|| | |||
*[[Fever]] | |||
*[[Abdominal pain]] | |||
*Bloody diarrhea | |||
*[[Headache]] | |||
*1-5 years old | |||
*Seizures in children | |||
|| | |||
*Food | |||
*Fecal-Oral | |||
|- | |||
| [[Yersinia]]||1-5 days|| | |||
*[[Appendicitis]] mimic, [[RLQ pain]] | |||
*[[Fever]] | |||
*[[Vomiting]] | |||
*Kids and Young Adults | |||
|| | |||
*Water | |||
*Milk | |||
*Pork | |||
*Wild Animals | |||
*Fecal-Oral | |||
|- | |||
| [[Campylobacter]]||1-7 days|| | |||
*Low grade [[fever]] | |||
*[[Abdominal pain]] | |||
*Kids and Young Adults | |||
*Guillain-Barre | |||
|| | |||
*Water | |||
*Poultry | |||
*Pets/Animals | |||
|- | |||
| [[C. Diff]]||1-11 Weeks|| | |||
*Copious FOUL diarrhea | |||
|| | |||
*Antibiotic use: [[PCN]], [[Clinda]], [[Cephalosporins]] | |||
|- | |||
| [[Entamoeba]]||1-11 weeks|| | |||
*[[Appendicitis]] Mimic | |||
*[[Abdominal pain]], [[nausea/vomiting]], [[diarrhea]] | |||
|| | |||
*Water | |||
*Sanitation | |||
*Travel | |||
|} | |||
==Clinical Features== | |||
*[[Vomiting]]/[[diarrhea]] | |||
*Crampy/diffuse [[abdominal pain]] | |||
==Differential Diagnosis== | |||
{{Nausea and vomiting DDX}} | |||
{{Abdominal Pain DDX Diffuse}} | |||
==Evaluation== | |||
*Assess hydration status | *Assess hydration status | ||
**Cap refill, skin turgor, | **Cap refill, skin turgor, respiratory rate | ||
*Consider stool labs if: | *Consider stool labs if: | ||
**>10 stools in previous 24hr | **>10 stools in previous 24hr | ||
**Travel to high-risk country | **[[Traveler's diarrhea|Travel to high-risk country]] | ||
**Fever | **Fever | ||
**Bloody stool | **Bloody stool | ||
**Persistent diarrhea | **Persistent diarrhea | ||
**HIV / immunosuppressed | |||
== | ==Management== | ||
#Rehydration (PO preferred) | |||
#*30mL(1oz)/kg/hr | |||
#Antiemetic | |||
#*[[Ondansetron]] 0.15mg/kg/dose IV/PO | |||
== | ===[[Antibiotics]]=== | ||
*''Only consider in patients with 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) | |||
*'''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 | *[[Nausea and vomiting]] | ||
*[[Acute gastroenteritis (peds)]] | |||
[[ | *[[Dehydration]] | ||
*[[Acute diarrhea]] | |||
[[ | |||
== | ==References== | ||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
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
Species | Onset | Symptoms | Transmission | Preformed Toxin |
---|---|---|---|---|
Viral (norovirus, adenovirus, rotavirus) | 11-72 hrs |
|
|
No |
Staph | 1-6 hrs |
|
|
Yes |
B. cereus | 1-6 hrs |
|
|
Yes |
C. perfringens | 8-24 hrs |
|
|
Yes |
V. cholerae | 11-72 hrs |
|
|
Yes |
Giardia | 1-4 wks |
|
|
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
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
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
Evaluation
- Assess hydration status
- Cap refill, skin turgor, respiratory rate
- Consider stool labs if:
- >10 stools in previous 24hr
- Travel to high-risk country
- Fever
- Bloody stool
- Persistent diarrhea
- HIV / immunosuppressed
Management
- Rehydration (PO preferred)
- 30mL(1oz)/kg/hr
- Antiemetic
- Ondansetron 0.15mg/kg/dose IV/PO
Antibiotics
- Only consider in patients with 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)
- OR ciprofloxacin
- OR TMP-SMX
- Ceftriaxone (parenteral)
Disposition
- Most can be discharged
Admit
- Unable to tolerate PO
- Hemodynamic instability
- Significant comorbidities