Wednesday, April 4, 2012


GASTROENTERITIS (gastro/gastric flu; stomach flu)

·         Inflammation of the gastrointestinal tract both the stomach & small intestines which leads to acute diarrhea.
·         Caused by infection, viruses, bacteria, parasites (protozoa, helminths) or adverse reaction to medications.
·         Most cases are seen during winter in the temperate climates & summer in the tropics.

Disease & Organism



Selected Bacterial Infections of the Bowel

Traveler’s diarrhea:
Escherichia coli

(24-72 hours)

Enterotoxin causes hypersecretion of the small intestines

Abrupt onset of diarrhea; vomiting rare

Prophylactic bismuth subsalicylate; antidiarrheals such as loperamide or diphenoxylate; 3-5 day course of norfloxacin, ciprofloxacin, or trimethoprim-sulfamethazole

Food poisoning

(2-8 hours)

Enterotoxin impairs intestinal absorption & affects vomiting centers in the brain

Severe nausea, vomiting; abdominal cramping, diarrhea; headache and fever

Fluid and electrolyte replacement as needed

Clostridium botulinum

(1.5-8 days)

Absorbed enterotoxin produces neuromuscular blockade and progressive paralysis

Diplopia, pupils fixed & dilated; dry mouth, dysphagia; progressive cephalocaudal weakness & paralysis; GI symptoms minimal

Gastric lavage to remove toxin from gut; administration botulinus antitoxin; respiratory, fluid and nutritional support

Vibrio Cholerae

(1-3 days)

Enterotoxin affects entire small intestine, causing secretion of water & electrolytes into bowel lumen

Severe diarrhea with “rice watery stool”, grey, cloudy, odorless, with no blood or pus; vomiting; thirst; oliguria, muscle cramps, weakness; dehydration

Oral or intravenous rehydration; possible antimicrobial therapy with ampicillin, tetracycline, trimethoprimsulfame-thoxazole, others

Hemorrhagic colitis:
 E. coli

(1-3 days )

Enterotoxin causes direct mucosal damage in large intestine; also toxic to vascular endothelial cells

Severe abdominal cramping, watery diarrhea that becomes grossly bloody; fever

Supportive care with fluid replacement and bland diet; may require dialysis or plasmapheresis for complications


(8-48 hours)

Superficial infection of the GI tract without invasion or production of toxins

Diarrhea with abdominal cramping, nausea, vomiting; low-grade fever, chills, weakness

Treatment of symptoms: trimetho-primsulfamethoxazole,
ampicillin, or cipro- floxacin for severe illness

Shigellosis (bacillary dysentery): Shigella

(1-4 days)

Local tissue invasion, primarily involving large intestine and distal ileum; endotoxin causes fluid and electrolyte secretion into bowel lumen
Watery diarrhea with severe abdominal cramping and tenesmus; lethargy
Fluid and electrolyte replacement; correction of acidosis; antibiotic therapy
Protozoal Infections of the  Bowel

Giadiasis: Giardia lamblia

(1-3 weeks or more)

Throphozite attaches to the mucosa in duodenum and jejunum, causing superficial invasion, inflammation, tissue destruction

Diarrhea, mild or severe, daily or intermittent; anorexia, nausea, vomiting;epigastric  pain, cramping, distention; flatulence, belching; may be asymptomatic

Metronidazole, quinacrine, furazolidone

Entamoeba histolytica

(2-4 weeks)

Organisms may reside in large intestine w/o causing disease or can invade colon wall, causing ulceration; may be carried via blood à liver à abscess

Usually asymptomatic; diarrhea may be mild, with few semiformed mucus containing stools per day, or severe, with 10-20 blood streaked liquid stools/day; abdominal cramps; colic, tenesmus, vomiting, tenderness; weight loss, fatigue

Diloxanide furoate or iodoquinol; chloroquine for hepatic abscess


(2-10 days)

Organisms attach to epithelial surface of small bowel(jejunum), causing villous atrophy and mild inflammatory changes

Asymptomatic to profuse, watery diarrhea of sudden onset, abdominal cramping; malaise, fever; anorexia, nausea, vomiting; electrolyte imbalance; weight loss

Self-limiting in immunocompetent clients.
For immuno-deficient:
spiramycin, zidovudine(AZT), paromomycin (Humatin), octreotide, eflornithine; fluid & electrolyte imbalance; parenteral nutrition
Selected Helminthic  Disease

Nematode Infections

(Ascaris, pinworm, hookworm, trichinosis)

Eggs are ingested in fecally contaminated food, under- cooked meats; it may enter through skin or by ingestion

Low-grade fever,cough,epigastric pain , vomiting, abdominal distention, nocturnal perianal, perineal pruritus, pruritic dermatitis, diarrhea, anorexia

Helminthic infections often treated with single oral dose or 3-day course of pyrantel pamoate (Antiminth®) or mebendazole (Vermox®);
Corticosteroids to reduce inflammation & manage symptoms

Cestode infections

(Intestinal fluke; tapeworms)

Organism is ingested by eating uncooked fish/meat, fecal contamination; swallowing infected hosts

Asymptomatic; diarrhea; abdominal pain; nausea, vomiting; thrombocytopenia, anorexia, weight loss, irritability
Signs & Symptoms: (Gastroenteritis)

ü  Anorexia
ü  Nausea & vomiting
ü  Orthostatic hypotension
ü  Fever
ü  Headache
ü  Loss of appetite
ü  Abdominal cramping & pain
ü  Borborygmi
ü  Increased bowel sounds
ü  Bloody stools
ü  Diarrhea
ü  Poor skin turgor
ü  Fatigue & weakness

Screening & Diagnosis:

·         Stool culture – reveals (+) organism that causes  infection, presence of WBC, blood, mucus in the stool
·         Complete blood count - ↑ hemoglobin & hematocrit related to presence of vomiting & diarrhea.
·         Kidney function test - ↑ creatinine & BUN


·         Hydration & electrolyte balance
·         Diet therapy– bland foods, avoid foods high in simple sugars because the osmotic load will worsen diarrhea.
·         Probiotics – to restore beneficial bacteria to the body. (e.g. yogurt, kimchee, sauerkraut, & kombucha)
·         Medications
o    Antibiotics: metronidazole,vancomycin, fluoroquinolone
o    Antidiarrheals: loperamide
o    Antihelmithic /antiparasitic: pyrantel pamoate (Antiminth®), mebendezole (Vermox®), iodoquinol (Amebaquine®), paromomycin (Humatin®)
o    Antiemetic: promethazine (Phenergan®)


·         Dehydration
·         Malabsorption

Nursing Interventions:

·         Rest bowel (NPO) for 24 hrs. before starting diet.
·         Administer prescribed medications.
·         Stress the importance of the following:
o    Oral rehydration
o    Proper handwashing, particularly before handling food, and after each bowel movement.
o    The need to wash contaminated clothing and linens separately in hot water and detergent.
o    Safe food storage, handling, and preparation.
o    Keeping toilet areas clean and maintain good personal hygiene.
·         Monitor for signs & symptoms for possible complications.

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