Difference between revisions of "Bacterial gastroenteritis"

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==Background==
 
==Background==
 
*Most acute gastroenteritis (AGE) is viral, not bacterial
 
*Most acute gastroenteritis (AGE) is viral, not bacterial
*Blood diarrhea suggests bacterial etiology
+
*[[rectal bleeding|Bloody diarrhea]] suggests bacterial etiology
*Do NOT diagnosis isolated vomiting as AGE
+
*Do NOT diagnose isolated vomiting as AGE
  
 
===Clinical Features and Causes===
 
===Clinical Features and Causes===
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|+ Noninvasive AGE
 
|+ Noninvasive AGE
 
|-
 
|-
! Species!! Onset !! Symptoms !! Transmisison !! Preformed Toxin
+
! Species!! Onset !! Symptoms !! Transmission !! Preformed Toxin
 
|-
 
|-
| Viral (norovirus, adenovirus, rotavirus)
+
| Viral ([[norovirus]], [[adenovirus]], [[rotavirus]])
 
|| 11-72 hrs
 
|| 11-72 hrs
 
||  
 
||  
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{{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 studeies if:
+
*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]]
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==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]]
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#*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)
 
#*[[Ceftriaxone]] (parenteral)
 +
 
==Disposition==
 
==Disposition==
 
*Most can be discharged
 
*Most can be discharged
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==References==
 
==References==
 
<references/>
 
<references/>
 +
 +
[[Category:ID]] [[Category:GI]]

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

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
No
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

Differential Diagnosis

Diffuse Abdominal pain

Nausea and vomiting

Critical

Emergent

Nonemergent

Evaluation

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

Management

  1. Rehydration (PO preferred)
  2. Antiemetic
  3. Antibiotics

Disposition

  • Most can be discharged
  • Admit
    • Unable to tolerate PO
    • Hemodynamic instability
    • Significant comorbidities

See Also

External Links

References