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Gastroenteritis - Coggle Diagram
Gastroenteritis
Diagnosis
Sudden-onset diarrhoea, blood or mucus in stool, faecal urgency.
Nausea or sudden onset vomitting
Fever or general malaise.
Abdominal pain or cramps.
Associated headache, myalgia, bloating, flatulence, weight loss and malabsorption.
Assessment
Examination
Features suggestive of alternative diagnosis
Weight and signs of malnutrition
Examine abdomen for distention, tenderness, masses and bowel sounds.
Assess for possible sepsis
Clinical features of dehydration/shock
Investigations: Stool sample not routinely indicated. Arrange if:
Recent travel out with Western Europe, North America, Australia or New Zealand
Recurrent or prolonged
Suspected food poisoning
Risk of transmission eg food handler, clinical, social care or nursery staff, person unable to perform adequate personal hygiene or clinical
Diarrhoea not resolved by day 7
Uncertainty about the diagnosis
Systemically unwell or immunocompromised
Contact with affected person: eg care home (norovirus), confirmed infection (symptomatic and asymptomatic at risk of transmitting disease)
History
Co-morbidities
Occupation
Any features of complications
Recent food intake that may suggest food poisoning
Risk factors for dehydration and current fluid intake, food intake and urinary output.
Onset, frequency, duration and severity of symptoms
Recent exposure to untreated or contaminated water
Symptoms eg diarrhoea, nausea, vomiting abdominal pain, fever, general malaise.
Recent foreign travel
Recent antibiotic/PPI use or hospital admission (increased risk of C.Diff)
Contact with other/outbreaks
Current drugs (Sick day rules) (Diuretics and ACE inhibitors may need to be stopped due to risk of AKI and dehydration)
Dehydration
Children: Dehydration
Warm extremities
Sunken eyes
Skin colour unchanged
Dry mucous membranes (except for mouth breathing)
Decreased urine output
Tachycardia
Altered responsiveness (eg irritable, lethargic)
Tachypnoea
Appears unwell or deteriorating
Normal peripheral pulses
Normal capillary refill time
Reduced skin turgor
Normal blood pressure
Adults
Moderate
Apathy/tiredness
Dizziness
Nausea
Headache
Muscle cramps
Pinched face
Dry tongue or sunken eyes
Reduced skin elasticity
Postural hypotension
Tachycardia
Oliguria
Severe
Hypotension
Tachycardia
Marked peripheral vasoconstriction
Uraemia, oliguria, anuria
Confusion leading to coma
Shock
Profound apathy or weakness
Mild
Lassitude
Anorexia and nausea
Light headedness
Possible postural hypotension
Children: Shock
Weak peripheral pulses
Prolonged capillary refill time
Tachypnoea
Tachycardia
Cold extremities
Pale or mottled skin
Decreased level of consciousness
Hypotension
Differential Diagnosis
Infective: Urinary tract infection, Pyelonephritis, Chest infection, Otitis media, sepsis.
Diarrhoea: Irritable bowel syndrome, inflammatory bowel syndrome, colorectal cancer, coeliac disease, constipation, diabetes, drugs eg antibiotics, laxative misuse etc.
Abdominal pain: Acute appendicitis, intestinal obstruction, biliary colic, acute cholecystitis, perforated peptic ulcer, diverticular disease, pancreatitis, testicular torsion, ectopic pregnancy.
Management: Adults
Primary Care
Use of antidiarrhoeal/antimotility, antiemetics and probiotics are not routinely recommended.
Do not routinely prescribe antibiotics.
Give advise on monitoring fluid intake and prevent/treat dehydration. Healthy adults: regular fluid/supplement with fruit juice or soup. Adults with increased risk of dehydration: use of oral rehydration salt solution as supplement to fluid. Clinical features of dehydration but safe to remain at home: Use of ORS frequently in small amount such as 200 - 400ml after every loose motion. Gradually reintroduce usual diet following rehydration.
Give advise on hand washing, cleaning toileting facilities, and washing soiled linen/clothes.
Provide advise on sources of support and information.
Do not attend work/school until 48 hours after last vomiting/diarrhoea episode
Seek urgent advise if any deterioration in condition requiring hospital admission, or features of blood, mucous and/or pus in stool requiring stool culture testing.
Notify local health protection team immediately through a notification form if any notifiable diseases/organisms are suspected.
Confirmed Microbiological cause
Cryptosporidiosis - no specific treatment licensed in the Uk seek specialist advise.
Campylobacteriosis: antibiotic not usually required in mild symptoms. If severe/immunocompromised - consider early prescribing of Clarithromycin 250-500mg twice daily for 5-7 days within 3 days onset of illness.
Admission
Consider admission if there are features of a potentially life threatening alternative diagnosis, or an inadequate response to ORS, or there are risk factors for dehydration or unable to safely manage at home.
Liaise with microbiology/consultant in communicable disease if uncertainty about the need for admission or uncertainty about management.
Emergency admission if systemically unwell/clinical features suggestive of severe dehydration, intractable vomiting or high output diarrhoea, suspected serious complication.
Gastroenteritis is a transient disorder due to enteric infection with viruses, bacteria, or parasites. It is characterized by the sudden onset of diarrhoea, with or without vomiting.