GASTROENTERITIS

Gastroenteritis is a general tern of infflammtion the stomach and intestinal tract (figure 4-5) it
commonly is caused by viral or bacterial infections and is characterized by varying degrees of
anorexia,nausea,vomiting,cramping pain and diarrhea.

EPIDEMIOLOGY

A number of specific illuesses fall under the heading of gastroenteritis.The most common are the
bacterial infections that cause “iraveler’s diarrhea” and the viral infections that frequently cause
epidemic outbreaks of “CI flu” most forms of infectious gastroenteritis are transmmited through
contaminated food and water or by direct or indirect fecal-oral transmission from an in fected person.

Resistance to gastroenteritis normally is provided by several components at work in a healthy

gastrointestinal tract a change in these components leaves an individual more susceptible to
pathogenic invasion.The resistance factors are the normal bacterial flora of the intestinal tract. The
market acidity of the stomach,and the normal motility of the gastrointestinal (CI)tract. The normal
bacterial flora proted the intestinal tractby comprting with pathogens for mucosal attachment sites or
by producing volatile organic acids.conditions or treatmentsthat alterthe normal bacterial flora (e.g.
antibioties and malnutrition) increase the individuai’s risk of pathogenic invasion.The normal gastric
acidity is important in eliminating ingested pathogens most bacteria cannot survive a gastric pH 3.0 or
less. Individuals at increased risk for bacterial gastroenteritis as a result of lass of normal gastric
acidity include patients with altought gastric pattiens who are taking antasid or antysecretory drugs
such as H2 receptor antagonistis and patientswho have had gastric surgery. Normal gastrointestinal
motility provides protection by purging the intestinal tract pathogens individuals with reduced
motility are at greater risk for pathogenic prolifcration that result in discase.Besides these factors age
and physical condition afleet resistance children the elderly and debilitated individuals are at greater
risk than healthy adults.

Bacterial gastroenteritis (“traveler’s diarrhea”) is more likely to occur in individuals traveling from
“low risk”(highly industrialized)countries to “high risk”(developing) countries. For example an
individual traveling from the United States to Mexico is more likely to be affeeted than an individual
traveling from mexico to the United States.

PATHOPHYSIOLOG

Viral and bacterial gastroenteritis is different from food poisoning in that the viruses or bacteria
invade and multiply withim the gastrointestinal tract.whereas food poisoning is caused by ingestion of
food contaminated with bacteria that have already multiplied withim the food pathogen that cause
gastroenteritis do so by one of the following meehanims: (1) secretion of an enterotoxin that causes
envere inflammation and secretory diarrhea (e.g.enterotoxigenic Escherichia coli) (2)invasion of the
intestinal wall,with resultant cellular destruction,necrosis,and possible ulceration (e.g Shigella and
Campylobacter organism); (3) mucosal attachment with resultant destruction of absorptive cells in the
intestinal villi (e.g.rotavirus) pathologie conditions resulting from the above processes include
reduced absorption of fluids and electrolytes and increased intestinal motility.with resultant diarrhea
and the potential for fluid and electrolyte imbalance.pathogens that secrete enterotoxins canse
excessive secretion of ffuilds and electrolytes into the intestinal lumen.resulting in large volume
diarrhea and the probability of severe fluid electrolyte imbalance (Examples of this type of
gastroenteritis include cholera and enterotoxigenic F coli)

The incubation period for viraland bacterial gastroenteritis ranges from 12 hours to 10 days,
depending on the specific organism involved. The onset of illness usually is marked by nausea.
Vomiting alxlominal cramping and fever diarrhea may accompany the ouset of illness or may begin
the following day.viral gastroenteritis tends to be self limiting usually lasting for 24 to 48 hours.
Bacterial gastroenteritis frequently lasts for as long as 5 to 10 days and require antibioties for
eradication. Table 4-1 provides a comparative overview of the most common types of viral bacterial
gastroenteritis.

COMPLICATIONS

Fluid and electrolyte imbalance (possibly severe) Ulcerative colitis (Campylobacter jejuni) Febrile
convulsions (campylobacter jejuni)