Acute gastroenteritis: Difference between revisions

Revision as of 13:33, 17 January 2026

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	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

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
- Disulfiram effect
- Erythromycin
- Ibuprofen
- Ipecac toxicity
Motion sickness
Narcotic withdrawal
Thyroid
Pregnancy
Peptic ulcer disease
Renal colic
UTI

Diffuse Abdominal pain

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

References

Authors:

@@ Line 7: / Line 7: @@
-==Background==
+==Background== <!--T:25-->
+<!--T:26-->
 *Blood diarrhea suggests bacterial etiology
 *Viral AGE usually lasts <7d
@@ Line 15: / Line 16: @@
-===Causes===
+===Causes=== <!--T:27-->
+<!--T:28-->
 {| class="wikitable"
 |+ Noninvasive AGE
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 |}
+<!--T:29-->
 {| class="wikitable sortable"
 |+ Invasive AGE
@@ Line 147: / Line 150: @@
-==Clinical Features==
+==Clinical Features== <!--T:30-->
+<!--T:31-->
 *[[Special:MyLanguage/Vomiting|Vomiting]]/[[Special:MyLanguage/diarrhea|diarrhea]]
 *Crampy/diffuse [[Special:MyLanguage/abdominal pain|abdominal pain]]
@@ Line 154: / Line 158: @@
-==Differential Diagnosis==
+==Differential Diagnosis== <!--T:32-->
 </translate>
@@ Line 165: / Line 169: @@
-==Evaluation==
+==Evaluation== <!--T:33-->
+<!--T:34-->
 *Assess hydration status
 **Cap refill, skin turgor, respiratory rate
@@ Line 179: / Line 184: @@
-==Management==
+==Management== <!--T:35-->
+<!--T:36-->
 #Rehydration (PO preferred)
 #*30mL(1oz)/kg/hr
@@ Line 188: / Line 194: @@
-===[[Special:MyLanguage/Antibiotics|Antibiotics]]===
+===[[Special:MyLanguage/Antibiotics|Antibiotics]]=== <!--T:37-->
+<!--T:38-->
 *''Only consider in patients with invasive infection''
 **[[Special:MyLanguage/Shigella|Shigella]], [[Special:MyLanguage/campylobacter|campylobacter]], [[Special:MyLanguage/E. coli|E. coli]], [[Special:MyLanguage/yersinia|yersinia]], [[Special:MyLanguage/vibrio|vibrio]]
@@ Line 203: / Line 210: @@
-==Disposition==
+==Disposition== <!--T:39-->
+<!--T:40-->
 *Most can be discharged
-===Admit===
+===Admit=== <!--T:41-->
+<!--T:42-->
 *Unable to tolerate PO
 *Hemodynamic instability
@@ Line 217: / Line 226: @@
-==See Also==
+==See Also== <!--T:43-->
+<!--T:44-->
 *[[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]]
 *[[Special:MyLanguage/Acute gastroenteritis (peds)|Acute gastroenteritis (peds)]]
@@ Line 226: / Line 236: @@
-==References==
+==References== <!--T:45-->
+<!--T:46-->
 <references/>
+<!--T:47-->
 [[Category:GI]]
 </translate>