Viral gastroenteritis: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 10: | Line 10: | ||
*Crampy/diffuse [[abdominal pain]] | *Crampy/diffuse [[abdominal pain]] | ||
*Features that suggest non-viral etiology: | *Features that suggest non-viral etiology: | ||
**Bloody diarrhea ([[Salmonella]], [[shigella]]) | **[[rectal bleeding|Bloody diarrhea]] ([[Salmonella]], [[shigella]]) | ||
**RLQ pain ([[ | **[[RLQ pain]] ([[Yersinia]], [[Entamoeba]]) | ||
**Recent antibiotics + copious, foul diarrhea ([[C. Diff]]) | **Recent [[antibiotics]] + copious, foul diarrhea ([[C. Diff]]) | ||
**Consumption of previously cooked/reheated foods (especially meats, | **Consumption of previously cooked/reheated foods (especially meats, mayonnaise, etc.) | ||
**Explosive, "rice-water" diarrhea ([[cholera]]) | **Explosive, "rice-water" diarrhea ([[cholera]]) | ||
**bloating, really nasty flatus/stools ([[giardia]]) | **bloating, really nasty flatus/stools ([[giardia]]) | ||
| Line 20: | Line 20: | ||
{{Abdominal Pain DDX Diffuse}} | {{Abdominal Pain DDX Diffuse}} | ||
{{Nausea and vomiting DDX}} | {{Nausea and vomiting DDX}} | ||
==Evaluation== | ==Evaluation== | ||
*Assess hydration status | *Assess hydration status | ||
| Line 26: | Line 27: | ||
**>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]] | ||
**Fever | **[[Fever]] | ||
**Bloody stool | **[[rectal bleeding|Bloody stool]] | ||
**Persistent diarrhea | **Persistent diarrhea | ||
==Management== | ==Management== | ||
#Rehydration (PO preferred) | #Rehydration (PO preferred) | ||
#*30mL(1oz)/kg/hr | #*30mL(1oz)/kg/hr | ||
#*[[Reduced-osmolarity oral rehydration solution]] | #*[[Reduced-osmolarity oral rehydration solution]] | ||
# | #[[Antiemetics]] | ||
#*[[Ondansetron]] 0.15mg/kg/dose IV/PO | #*[[Ondansetron]] 0.15mg/kg/dose IV/PO | ||
#*May worsen diarrhea | #*May worsen diarrhea | ||
Latest revision as of 16:49, 30 September 2019
See Acute gastroenteritis (peds) for pediatric patients
Background
- Most common cause of acute gastroenteritis (AGE)
- Viral gastroenteritis usually lasts <7d
- Do NOT diagnosis isolated vomiting as AGE!
Clinical Features
- Vomiting
- Watery, non-bloody diarrhea
- Crampy/diffuse abdominal pain
- Features that suggest non-viral etiology:
- Bloody diarrhea (Salmonella, shigella)
- RLQ pain (Yersinia, Entamoeba)
- Recent antibiotics + copious, foul diarrhea (C. Diff)
- Consumption of previously cooked/reheated foods (especially meats, mayonnaise, etc.)
- Explosive, "rice-water" diarrhea (cholera)
- bloating, really nasty flatus/stools (giardia)
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
- Antiemetics
- Ondansetron 0.15mg/kg/dose IV/PO
- May worsen diarrhea
Disposition
- Most can be discharged
Admit
- Unable to tolerate PO
- Hemodynamic instability
- Significant comorbidities