Paediatric gastroenteritis

Definition

This is the inflammation of the mucous membranes of the stomach and intestines.

Epidemiology

In the UK, 204 of 1000 consultations for children under 5 years old, concern gastroenteritis. 7 in 1000 are admitted to hospital. In the developing world, it responsible for the death of 5 million under-5s a year.

Pathophysiology

The pathogen, usually a bacteria or a virus, enters the system orally. Generally, insufficiently cooked food and bad water due to poor sanitation are where the pathogens come from. In the developed world, rotavirus is responsible for 60% of cases under 2, particularly during the winter months.

Bacterial gastroenteritis is less common in the developed world but the main organisms implicated are Campylobacter jejuni, Shigella, Vibrio cholerae and enterotoxigenic Escherichia coli (E.coli).

Risk Factors

• Poor hygeine
• Poor sanitation
• Poorly cooked, poorly reheated or uncooked food - fails to kill bacteria
  • NB: most gastroenteritis is caused by viruses
  • Staphlylococcal exotoxins can survive the reheating process though this is rarely the cause of gastroenteritis

Clinical Features

• Nausea And Vomiting
• Diarrhoea
• Abdominal Pain
• Fever

These aren't particularly specific. In children, vomiting and fever could easily be meningitis, respiratory infection - basically any infection. Another important set of clinical features to know are the signs of dehydration. These are really, really important to know as most management of gastroenteritis is based around them. LEARN THEM OR YOU WILL DIE (maybe)!

Bacterial

The above is true of all gastroenteritis but there are some extra symptoms in some bacteria:

• Presence of blood in stool
• Camplyobacter - abdo pain is severe
• Shigella - blood, pus, pain and tenesmus (constant feeling of needing to poo). Maybe accompanied by febrile convulsions.
• Cholera and E.coli cause profuse and rapidly dehydrating diarrhoea.

It should be noted that these symptoms are poor at differentiating between the different bacterial pathogens.

Investigations

Bloods

• FBC - this is to confirm infection (↑WCC)
• U&Es - electrolyte monitoring is incredibly important. U&Es are required in order to measure Na⁺ levels which useful to measure the levels of dehydration and whether the child needs salt.

Cultures

If it is suspected that the pathogen is part of an outbreak or it is a notifiable disease, a stool sample can be sent for culture.

Management

The management of gastroenteritis is essentially, the management of dehydration. As I said earlier, it's quite important because if you can manage dehydration, you can pretty much manage gastroenteritis. Which is good because that will make you an ace doctor.

Generally, antibiotics are not indicated because they don't slow progress of the disease and viruses are responsible for the majority of gastroenteritis

Prognosis

There are no common complications following a bout of gastroenteritis, so long as the patient survives it (which is highly likely in developed countries).