Emad A. KelantanMedical Intern

A 13 year old boy came to the PHC complaining of a recent episode of vomiting and watery stool, preceded by abdominal cramps and discomfort.

Q1: what is your Dx?A: Gastroenteritis.

Q2: What is your approch? Q3: How will you manage such a case

in the ER?

1.The Severity.

2.The Golden Concept In Managing Any Disease:

Causes (DDx)

Present Complain

Complications

The Signs and Symptoms of Dehydration

Signs Symptoms

Dry Skin (skin turgor )

Dark Colored Urine

Dry Mouth postural

hypotension 

Thirst

Loss of Appetite

dizziness, faintness or light-headedness when they stand up

Mild ( 2% )

Signs Symptoms Increased heart rate

Increased respiration

Increased body temperature

Sunken of the eye

Prolonged capillary refill ( > 2 sec )

BP normal or low

Decreased sweating

Decreased urination

Extreme fatigue

Muscle cramps

Headaches

Nausea

Tingling of the limbs

Moderate (5% )

Signs Symptoms Racing pulse

Low blood pressure

Increased respiration

Dry Skin (skin turgor ) retracts very slowly

Sunken of the eye

Prolonged capillary refill ( > 2 sec )

Muscle spasms

Vomiting

Dim vision

Painful urination

Confusion

Difficulty breathing

Seizures

Chest and Abdominal pain

Severe ( 10% or more )

Management & TreatmentIn PHC

Complications of Gastroenteritis

Pseudomembranous Colitis.

inflammation of the colon by Clostridium difficile, caused by treatment with antibiotics.

symptoms: diarrhea, cramping abdominal pain, blood in the stool, nausea,

vomiting, and fever. Treatment : I. Stop antibiotics.II. Oral vancomycin.

Electrolyte Imbalance

Hypokalemia and hypernatremia

Due conyineous diarria

Treatment: intravenous fluids, and oral potassium supplements .

Hypovolemic Shock

Due to the sever dehydration

Symptom??? :

Treatment ??? :

GBS

Occur after 2 week of gastritis

Symptoms : proximal muscle weakness, absent of tendon reflex, hypotonia.

Treatment: 1) I.V. IG. 2) plasma phoreses.

Differential diagnosis

• Infection• Acute Abdomen • Bowel Obstruction• Inflammatory Bowel disease • Food Allergies• Drugs

Infection

• Viruses : the most common Norovirus(Caliciviridae), Rotavirus , Adenoviruses (Respiratory), Parvoviruses, HIB A.

• Bacteria : Staphylococcus aureus, Escherichia coli, Salmonella, Campylobacter,Shigella, Clostridium difficile .

• Parasites :Giardia, Antamiba histolotica Cryptosporidium .

Diagnosis of infection

• CBC , Chemistry , electrolytes , Abdominal Imaging.• Bacterial : Sign( High fever, Bloody dairrhea, sever

abdominal pain ) + Investigation (Test of blood for WBC by methylene blue +ve Culture .

• Viral :short prodrome, with mild fever and vomiting, followed by 1-4 days of nonbloody, watery diarrhea) Rapid antigen testing of the stool.

• Parasites :Direct Examination of stool for eggs & AFB satin for Cryptosporidia .

Treatment • IF Viral Self limiting • IF Bacterial Proper Antibiotic • With invasive pathogen Ciprofloxacin • IF Protzol Metronidazol

• If acute abdomen Investigate for Dx then decide suitable management.

• If it was due to chemical toxins or drugs stop the expouser.