Gastroenteritis

Basics

Description

Inflammation of stomach and intestines associated with diarrhea and vomiting; often the result of infectious or toxin exposure

Etiology

Infectious

Viruses:
- 50–70% of all cases with Norovirus cases on the rise in travelers returning from Mexico and India
Invasive bacteria:
- Campylobacter: Contaminated food or water, wilderness water, birds, and animals:
  - Most common cause
  - Gross or occult blood is found in 60–90%
- Salmonella: Contaminated water, eggs, poultry, or dairy products:
  - Typhoid fever (Salmonella typhi) characterized by unremitting fever, abdominal pain, rose spots, splenomegaly, and bradycardia
  - Immunocompromised susceptible
- Shigella: Fecal–oral route
- Vibrio parahaemolyticus: Raw and undercooked seafood
- Yersinia: Contaminated food (pork), water, and milk:
  - May present as mesenteric adenitis or mimic appendicitis
- Specific food-borne disease (food poisoning):
  - Staphylococcus aureus:
    - Most common toxin-related disease
    - Symptoms within 1–6 hr after ingesting food
  - Bacillus cereus:
    - Classic source is fried rice left on steam tables
    - Symptoms within 1–36 hr
- Cholera: Profuse watery stools with mucous (rice-water stools)
- Ciguatera:
  - Fish intoxication
  - Onset 5 min–30 hr (average 6 hr) after ingestion
  - Paresthesias, hypotension, peripheral muscle weakness
- Scombroid:
  - Caused by blood fish: Tuna, albacore, mackerel, and mahi-mahi
  - Flushing, headache, erythema, dizziness, blurred vision, and generalized burning sensation
  - Symptoms last <6 hr
  - Treatment includes antihistamines
Protozoa:
- Giardia lamblia:
  - High-risk groups: Travelers, day care children, homosexual men, and campers who drink untreated mountain water

Noninfectious Causes

Toxins:
- Zinc, copper, cadmium
- Organic chemicals: Polyvinyl chlorides
- Pesticides: Organophosphates
- Radioactive substances
- Alkyl mercury
Altered host response to food substance (tyramine, monosodium glutamate, tryptamine)

Pediatric Considerations

Focus evaluation on state of hydration
Most of viral origin and self-limited
Rotavirus accounts for up to 50%
Shigella infections associated with seizures

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