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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.