Bacterial gastroenteritis: Difference between revisions
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==Background== | ==Background== | ||
*Most acute gastroenteritis (AGE) is viral, not bacterial | *Most acute gastroenteritis (AGE) is viral, not bacterial | ||
* | *[[rectal bleeding|Bloody diarrhea]] suggests bacterial etiology | ||
*Do NOT | *Do NOT diagnose isolated vomiting as AGE | ||
===Clinical Features and Causes=== | ===Clinical Features and Causes=== | ||
Line 9: | Line 9: | ||
|+ Noninvasive AGE | |+ Noninvasive AGE | ||
|- | |- | ||
! Species!! Onset !! Symptoms !! | ! Species!! Onset !! Symptoms !! Transmission !! Preformed Toxin | ||
|- | |- | ||
| Viral (norovirus, adenovirus, rotavirus) | | Viral ([[norovirus]], [[adenovirus]], [[rotavirus]]) | ||
|| 11-72 hrs | || 11-72 hrs | ||
|| | || | ||
Line 136: | Line 136: | ||
{{Abdominal Pain DDX Diffuse}} | {{Abdominal Pain DDX Diffuse}} | ||
{{Nausea and vomiting DDX}} | {{Nausea and vomiting DDX}} | ||
==Evaluation== | ==Evaluation== | ||
*Assess hydration status | *Assess hydration status | ||
**Cap refill, skin turgor, respiratory rate | **Cap refill, skin turgor, respiratory rate | ||
*Consider stool | *Consider stool studies if: | ||
**>10 stools in previous 24hr | **>10 stools in previous 24hr | ||
**[[Traveler's diarrhea|Travel to high-risk country]] | **[[Traveler's diarrhea|Travel to high-risk country]] | ||
Line 147: | Line 148: | ||
==Management== | ==Management== | ||
#Rehydration (PO preferred) | #[[oral rehydration therapy|Rehydration]] (PO preferred) | ||
#*30mL(1oz)/kg/hr | #*30mL(1oz)/kg/hr | ||
#*[[Reduced-osmolarity oral rehydration solution]] | #*[[Reduced-osmolarity oral rehydration solution]] | ||
Line 158: | Line 159: | ||
#*NOT indicated for [[E. coli]] O157:H7 | #*NOT indicated for [[E. coli]] O157:H7 | ||
#*NOT routinely indicated for salmonella | #*NOT routinely indicated for salmonella | ||
#**Exceptions: SCD, [[IBD]], <3mo | #**Exceptions: [[sickle cell|SCD]], [[IBD]], <3mo | ||
#*[[Azithromycin]] (able to tolerate PO) | #*[[Azithromycin]] (able to tolerate PO) | ||
#*OR [[ciprofloxacin]] | #*'''OR''' [[ciprofloxacin]] | ||
#*OR [[TMP-SMX]] | #*'''OR''' [[TMP-SMX]] | ||
#* | #*[[Ceftriaxone]] (parenteral) | ||
==Disposition== | ==Disposition== | ||
*Most can be discharged | *Most can be discharged |
Latest revision as of 19:33, 29 September 2019
See Acute gastroenteritis (peds) for pediatric patients
Background
- Most acute gastroenteritis (AGE) is viral, not bacterial
- Bloody diarrhea suggests bacterial etiology
- Do NOT diagnose isolated vomiting as AGE
Clinical Features and 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 |
|
|
No |
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 |
|
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
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
Evaluation
- Assess hydration status
- Cap refill, skin turgor, respiratory rate
- Consider stool studies if:
- >10 stools in previous 24hr
- Travel to high-risk country
- Fever
- Bloody stool
- Persistent diarrhea
Management
- Rehydration (PO preferred)
- 30mL(1oz)/kg/hr
- Reduced-osmolarity oral rehydration solution
- 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
- Azithromycin (able to tolerate PO)
- OR ciprofloxacin
- OR TMP-SMX
- Ceftriaxone (parenteral)
- Only consider in patients with invasive infection
Disposition
- Most can be discharged
- Admit
- Unable to tolerate PO
- Hemodynamic instability
- Significant comorbidities