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Gastroenteritis

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Urology

Good Handwashing and appropriate food handling is key to preventing the spread of further disease.

About

Inflammation of the stomach and intestinal epithelium and submucosa
Typically acute and infective coming on soon after exposure to agent
Most cases never come near the hospital
Close monitoring e.g. admission for IV fluids for diabetics, pregnancy, paediatrics, immunocompromised, elderly, coexisting diseases

Causes

Causes	Examples
Viruses	rotavirus, adenovirus, astrovirus, small round viruses, Norwalk virus
Bacteria	Campylobacter jejuni, Escherichia coli (O157), Salmonella, Shigella, Vibrio cholerae, Staph aureus, Clostridium botulinum, Clostridium perfringens, Bacillus cereus, Clostridioides difficile
Protozoa	Entamoeba histolytica, Cryptosporidium parvum, Giardia lamblia
Toxins	seafood, mushrooms, Scombrotoxin , Ciguatera fish poisoning

Mechanism

Mechanism	Example
Non inflammatory	Vibrio cholerae, Enterotoxigenic E.coli produce toxins which cause the cells lining the gut to secrete water and electrolytes
Inflammatory	Enteroinvasive E.coli and Shigella and salmonella typhi release cytokines and generally damage the epithelium

Organisms	Code: D=Diarrhoea, V = Vomiting AP=Abdominal pain F=fever S=Sepsis
Staph aureus	D&V&AP within 6 hrs of ingestion of infected meat
Bacillus cereus	D/V Within 6 hours of ingestion of infected rice
Scombrotoxin	D/V and Flushing and hot mouth within 1 hour of eating fish. Scombroid fish poisoning is due to ingestion of food high in Histamine. Antihistamines are given and fluid resuscitation. Proper storage after the fish is caught would prevent this
Ciguatera fish poisoning	D/V/AP tingling all over. Within minutes of ingestion. Ciguatera fish poisoning is due to fish that contain a dinoflagellate that releases ciguatoxin. Management is supportive with fluid replacement. Patients feel hot when cold and vice versa. Diarrhoea and cramps persist. Unusual sensations may persist for many months
Salmonella	D/V/AP/F/S Between 12 and 48 hours after infected meat, eggs, chicken
Norovirus	D/V(projectile)/AP within 12-48 hrs. Faeco-oral and from vomitus. Infectious even after symptoms resolve up to 48 hrs
Rotavirus	D/V/F within 1-7 days
Clostridium botulinum	V/Paralysis/Botulism from canned and processed foods. Diplopia, facial weakness and weakness in his arms and hyporeflexia
Clostridioides difficile	V/D/AP. Seen In those on broad-spectrum antibiotics. Faeco-oral spread. Spores. Toxin producing. Pseudomembranous colitis. Toxic megacolon
Clostridium perfringens	D/AP from meat within 24 hours
Vibrio cholerae	See section. From contaminated water.
Campylobacter	D(bloody)/V/F/Acute AP within 5 days of milk, chicken, water. May develop Guillain-Barré syndrome.
E.Coli O157	D(bloody), D/V/F/P within 12-72 h,Haemolytic uraemic syndrome
Yersinia enterocolitica	D, AP, F from infected milk
Cryptosporidium parvum	D/Cramps. Associated with HIV and life-threatening if low CD4. From infected unboiled water. Incubation period 4-12 days
Giardia lamblia	D/Malabsorption from cats,dogs within 1 wk-1 month
Entamoeba histolytica	D/Malabsorption within 1 wk-1 month
Shigella	D(bloody)/Fever,AP within2-3 day of infection from food
Vibrio parahaemolyticus	D/AP/V within 48 hours of infected seafood

Clinical

Acute onset of nausea, vomiting, anorexia, fever in some cases
Waves of Intestinal colic and diarrhoea which may be watery faeces initially or mucus or even blood-stained
Abdominal discomfort, ↑ Bowel sounds
Dehydration and hypotension in severe cases

Investigations

Done only in a select few with severe symptoms
FBC ↑ WCC ↑ CRP
U&E ↑ Urea, ↑ Creatinine if dehydrated or ↑↑ may suggest renal failure associated with E Coli O157
Stool samples for microscopy and culture and toxin analysis
Blood cultures if pyrexial
AXR - may show gas-filled bowel loops, no faeces

Prevention when abroad

Avoid unbottled or unboiled water
Avoid ice cubes and salads and peel your own fruit
Recently prepared hot food only

Management

Fluid management using IV fluids if needed
Oral rehydration sachets
Loperamide and Codeine phosphate can be used
Ciprofloxacin if salmonella, shigella or campylobacter suspected with systemic infection or if elderly or immunocompromised
Notifiable disease in the United Kingdom

Important complications

Guillain-Barré syndrome with campylobacter
Haemolytic uraemic syndrome with E.coli O157
Precipitate Diabetic ketoacidosis in Type 1 DM not following sick day rules
Hypovolaemic shock
Muscle weakness - Botulinum toxin

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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