Viral gastroenteritis
See Acute gastroenteritis (peds) for pediatric patients
Background
- Most common cause of acute gastroenteritis (AGE)
- Viral gastroenteritis usually lasts <7d
- Do NOT diagnosis isolated vomiting as AGE!
Clinical Features
- Vomiting
- Watery, non-bloody diarrhea
- Crampy/diffuse abdominal pain
- Features that suggest non-viral etiology:
- Bloody diarrhea (Salmonella, shigella)
- RLQ pain (Yersinia, Entamoeba)
- Recent antibiotics + copious, foul diarrhea (C. Diff)
- Consumption of previously cooked/reheated foods (especially meats, mayonnaise, etc.)
- Explosive, "rice-water" diarrhea (cholera)
- bloating, really nasty flatus/stools (giardia)
Differential Diagnosis
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Gastroparesis
- Diabetic ketoacidosis
- Hernia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Acetaminophen toxicity
- Adrenal insufficiency
- Appendicitis
- Aspirin toxicity
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Digoxin toxicity
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
- Theophylline toxicity
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Disulfiram effect
- Erythromycin
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Ibuprofen
- Ipecac toxicity
- Labyrinthitis
- Migraine
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
Evaluation
- Assess hydration status
- Cap refill, skin turgor, respiratory rate
- Consider stool studies if:
- >10 stools in previous 24hr
- Travel to high-risk country
- Fever
- Bloody stool
- Persistent diarrhea
Management
- Rehydration (PO preferred)
- 30mL(1oz)/kg/hr
- Reduced-osmolarity oral rehydration solution
- Antiemetics
- Ondansetron 0.15mg/kg/dose IV/PO
- May worsen diarrhea
Disposition
- Most can be discharged
Admit
- Unable to tolerate PO
- Hemodynamic instability
- Significant comorbidities
See Also
- Acute gastroenteritis
- Nausea and Vomiting
- Acute gastroenteritis (peds)
- Dehydration
- Acute diarrhea
References
This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.