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Gastroenteritis

Gastroenteritis is a topic covered in the 5-Minute Emergency Consult.

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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
      • Amitriptyline may be therapeutic.
    • 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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Citation

Rosen, Peter, et al., editors. "Gastroenteritis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307544/all/Gastroenteritis.
Gastroenteritis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307544/all/Gastroenteritis. Accessed April 26, 2019.
Gastroenteritis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307544/all/Gastroenteritis
Gastroenteritis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307544/all/Gastroenteritis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Gastroenteritis ID - 307544 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307544/all/Gastroenteritis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -