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Gastroentritis for phc rotation

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Emad Kelantan

A 13-year-old boy presented to the primary health center complaining of recent vomiting, watery stool, abdominal cramps and discomfort. The document discusses evaluating and managing gastroenteritis, including assessing for dehydration, treating any underlying infection, and providing intravenous fluids and electrolyte replacement as needed. The differential diagnosis and potential complications are also reviewed.

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Gastroentritis for phc rotation
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:
The Signs and Symptoms of Dehydration
Symptoms Signs Thirst Dry Skin (skin turgor ) Mild ( 2% ) Loss of Appetite Dark Colored Urine Dry Mouth dizziness, faintness or postural hypotension light-headedness when they stand up
Symptoms Signs Moderate (5% ) Decreased sweating Increased heart rate Decreased urination Increased respiration Extreme fatigue Increased body temperature Muscle cramps Sunken of the eye Headaches Prolonged capillary refill ( > 2 sec ) Nausea BP normal or low Tingling of the limbs
Symptoms Signs Severe ( 10% or more ) Muscle spasms Racing pulse Vomiting Low blood pressure Dim vision Increased respiration Painful urination Dry Skin (skin turgor ) retracts very slowly Confusion Sunken of the eye Difficulty breathing Prolonged capillary refill ( > 2 Seizures sec ) Chest and Abdominal pain
Management & Treatment In 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.

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Gastroentritis for phc rotation

  • 2. 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?
  • 3. 1. The Severity. 2. The Golden Concept In Managing Any Disease:
  • 4. The Signs and Symptoms of Dehydration
  • 5. Symptoms Signs Thirst Dry Skin (skin turgor ) Mild ( 2% ) Loss of Appetite Dark Colored Urine Dry Mouth dizziness, faintness or postural hypotension light-headedness when they stand up
  • 6. Symptoms Signs Moderate (5% ) Decreased sweating Increased heart rate Decreased urination Increased respiration Extreme fatigue Increased body temperature Muscle cramps Sunken of the eye Headaches Prolonged capillary refill ( > 2 sec ) Nausea BP normal or low Tingling of the limbs
  • 7. Symptoms Signs Severe ( 10% or more ) Muscle spasms Racing pulse Vomiting Low blood pressure Dim vision Increased respiration Painful urination Dry Skin (skin turgor ) retracts very slowly Confusion Sunken of the eye Difficulty breathing Prolonged capillary refill ( > 2 Seizures sec ) Chest and Abdominal pain
  • 10. 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.
  • 11. Electrolyte Imbalance Hypokalemia and hypernatremia Due conyineous diarria Treatment: intravenous fluids, and oral potassium supplements.
  • 12. Hypovolemic Shock Due to the sever dehydration Symptom: ??? Treatment: ???
  • 13. GBS Occur after 2 week of gastritis Symptoms : proximal muscle weakness, absent of tendon reflex, hypotonia. Treatment: 1) I.V. IG. 2) plasma phoreses.
  • 14. Differential diagnosis • Infection • Acute Abdomen • Bowel Obstruction • Inflammatory Bowel disease • Food Allergies • Drugs
  • 15. 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 .
  • 16. 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 .
  • 17. 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.

Editor's Notes

  • #11: What is pseudomembranous colitis?A person with pseudomembranous colitis has severe inflammation of the colon, caused by treatment with antibiotics. The antibiotics kill the bacteria that normally live in the colon. This leads to an overgrowth of bacteria, called Clostridium difficile, which invade the wall of the colon and cause inflammation. About 1 out of every 15,000 people treated with an antibiotic develop pseudomembranous colitis. What are the symptoms of pseudomembranous colitis?Symptoms of pseudomembranous colitis include diarrhea, cramping abdominal pain, blood in the stool, nausea, vomiting, and fever.How does the doctor treat pseudomembranous colitis?Treatment for pseudomembranous colitis includes plenty of liquids, a bland diet, and antibiotics.
  • #12: What is hypernatremia?A person with hypernatremia has abnormally high levels of sodium in the bloodstream. Hypernatremia is commonly caused by dehydration or a drug side effect. What are the symptoms of hypernatremia?Symptoms of hypernatremia include muscle tremors, irritability, confusion, and fatigue.How does the doctor treat hypernatremia?Treatment for hypernatremia may include oral fluids or intravenous fluids.What is hypokalemia?A person with hypokalemia has abnormally low levels of potassium in the bloodstream. Hypokalemia is often caused by persistent diarrhea or a drug side effect. What are the symptoms of hypokalemia?Symptoms of hypokalemia include excessive thirst, muscle twitching, muscle weakness, muscle cramps, leg pain (bilateral), palpitations, and confusion.How does the doctor treat hypokalemia?Treatment for hypokalemia may include intravenous fluids, potassium rich foods, and oral potassium supplements.
  • #13: What is shock?A person with shock has a life-threatening condition that prevents the heart and bloodstream from delivering enough oxygen to keep up with the body's demands. Prolonged shock results in the death of cells, because they do not receive enough oxygen. Shock may be caused by heart failure, poor blood flow to the lungs, severe blood loss, or severe dilation of the blood vessels throughout the body.What are the symptoms of shock?Symptoms of shock include low blood pressure, rapid heart rate, difficulty breathing, pale skin, excessive sweating, excessive sleepiness, fainting, cool limbs, confusion, and coma. How does the doctor treat shock?The treatment for shock depends on the underlying cause. Treatment for shock may include, intravenous fluids, cardiac monitoring, oxygen therapy, corticosteroid medications, antibiotics, medications for low blood pressure, surgery, blood transfusions, or a ventilator to support breathing.