1. GASTROENTERITIS
Presented by
BScN.KRCHN. Paul Mutie Cyrus
Pwani university

2. PEDIATRIC
GASTROENTERITIS.
Causative agents
Pathophysiology
Types of diarhea
Classification of diarhea
Management.

3.  DEFINITION;Gastroenteritis is an
inflamatory disease of the gastric,and
enteric sites of the gastrointestinal tract.
 It is characterised by a sudden onset of
diarhea with or without vomiting.
 Diarhea in infants and small children may
quikly dehydrate or get hypovolemic shock
if fluids and electrolytes are not admistered
immediately.
 Causes include;virus,bacteria,protozoal,and
non infectious causes.

4. 1.Viral causes.
 Viruses account for the largest causes
of diarhea in pediatrics
 Rotavirus is the leading viral pathogen
worldwide.
 Others;calivirus,astovirus,norovirus,an
d adenovirus in gastroenteritis.

5. Symptoms of viral
gastroenteritis.
 Low grade fever.
 Vomiting
 Copious watery diarhea.
 Symptoms persist in 3-8 days.

6. 2.Bacterial agents
 Also called food poisoning.
 Bacteria is the second leading cause
of diarhea in peaeiatrics.
 Compylobacter Jejuni is the leading
bacterial cause of gastroenteritis
developed countries.
 Other forms of bacteria
include;shigella,Enterohemorhagic
Escherichia coli,and salmonella
enterica in developed countries.

7.  In developing
countries;Enterotoxigenic ecoli is the
leading cause of gastroenteritis of the
paediatrics.
 Others include;compylobacter
jejuni,shigella and salmonela enterica.

8. Symptoms of Bacterial
gastroenteritis.
 High fevers.
 Shaking chills.
 Dysentery,(bloody bowel movements).
 Abdominal cramping.
 Fecal leukocytes.

9. 3.History of antibiotics use.
 A history of recent use of antibiotics
like;penicillins,cephalosporins,and
clyndamycim, to the pediatrics may
increase the likelyhood of toxix
chlostridium difficile infexion,which
causes gastroenteritis.
 50% of neonates are colonised with
chlostridium difficile hence
symptomatic diesease is unlikely to
occur in them.

10. 4.Parasites
 A number of protozoans like;Giardia
lamblia,Entamoeba hystolitica,and
crystosporidium,remain the leading
cause of gastroenteritis inpaediatrics.
 Symptoms include;watery stool,and
travel to an endemic area.

11. Transmission.
 Bottle feeding of babies with
unsanitized bottles.
 Poor hygiene among children in
crowded areas.
 Prexisting poor nutritional status.

12. 5.Non-infectious causes.
 Include medications like NSAIDS.
 Foods like lactose(to those who are
intolerant)
 Crohns diesease.

13. Pathophysiology of
gastroenteritis.
 GE is defined as vomiting or diarhea due
to infections of the small or large
intestines.
 Changes are majorly non-inflammatory,in
the small intestines,but inflammatory in
large intestines.
 Abdominal crambs,increased thirst,due
to excessive water dehydration and
scanty urine occurs.
 Most dangerous symptoms include,high
fever above 38.9 degrees celcius,blood
or mucus in the diarhea,blood in the
vomit,and severe abdominal pains or
swellings.

14. cntd, Phathophysiology
 Most of the infective microrganisms
mentioned like;viruses,bacteria,and
protozoans,damage the mucosal lining
or the brushborder in the small
intestines.
 Loss of protein-rich fluids and decreased
ability to absorb the lost fluids occurs.
 Invasion of the intestinall wall may cause
bleeding especially incase of
shigella,E.hystolytica and salmonella
enterica.
 Loss of a lot of water salts causes
dehydration.

15. TYPES OF DIARRHEA.
A.Secretory diarrhea.
 Caused by increased active secretion
or due to inhibition of absorption.
 Occurs due to secretion of anions
especially the chloride ions.
 Main cause is cholera toxins.
 Intestinal fluid secretion is isotonic
with plasma even during fasting.
 To maintain a charge balance in the
lumen,sodium is carried along with
water.

16. 2.Osmotic diarrhea.
 Occurs when water is drawn into the
bowels.
 Excessive drinking of fluids with
excess sugar and salt may also be a
cause.
 May also result from mal-absorption
e.g pancreatic disease or celiac
disease.
 Laxatives,constipation,or too much of
magnesium,vitamin c,or undigested

17. 3.Motility related diarrhea.
 Hypermotility diarrhea.
 Due to hypermotility of the
intestines,no sufficient time for
sufficient nutrient and water
absorption.
 Its may be due to a vagotomy or
diabetic neouropathy.

18. 4.Exudative diarrhea.
 Caused by presence of pus and blood
in the lumen.
 Occurs with inflammatory bowel
disease like chrohns
disease,ulcerative colitis,and severe
infections like E.coli.

19. 5.Inflammatory diarrhea.
 Occurs due to the mucosal damage to
the mucosal lining or brush
border,causing passive loss of protein-
rich fluids and a decreased ability to
absorb the lost fluid.
 Majorly due to viral infections,parasitic
infections,or autoimmune problems.

20. 6.Dysentery.
 It’s a blood stained diarrhea.
 Blood presence indicates invasion of
the bowel tissue by microrganisms like
shigella,Entamoeba hystolitica and
salmonella enterica.

21. 7.Infectious diarrhea.
 Mainly caused by virus,and bacteria.
 Norovirus,rotavirus,and adenovirus
are the most significant causes of viral
diarrhea.
 Compylobacter spp. Is the most
common cause of bacterial diarrhea.
 Salmonella,shigella spp.and some
strains of E.coli too contribute as
causative agents.

22. Diagnostic investigations of
GE.
 Stool samples are collected for
microscopy.A stoll sample in viral GE
does not contain any recognisable
exudate,and its free from inflamatory
cells,blood and fibrin.
 Presence of leukocytes indicates
presence of bacterial agent.
 Cysts and trophozoites indicate parasitic
GE.
 Blood tests for;FBC,renal function and
electrolytes can also be done to rule any
systemic effects.
 Blood culture if giving antibiotics therapy.

23. Dehydration due to diarrhea
according to WHO.
 Dehydration is defined as an incident
in which water and
electrolytes(sodium,pottasium,and
bicarbonate)are lost through liquid
stools,vomit,sweat,urine and
breathing.
 Dehydration occurs when these losses
are not replaced.

24. Classification of dehydration.
1.Early dehydration .The body has lost about 2%of its total
fluids.No signs or symptoms.
2.Moderate dehydration.Its characterised by;
 Thirst
 Restless or irritable behaviour.
 Decreased skin elasticity.
 Sunken eyes.
 Decreased urine output.Less than six diapers in babies
and eight hours of older children without urination.
 Few or no tears when crying.
 Lghtheadedness or dizziness.
 Sleeplessnes or tiredness.
 Muscle weaknes.

25. 3.Severe dehydration.
 Its characterised by;
1. Shock
2. Diminished consciousnes and delirium.
3. Little or no urine output.
4. Cool and moist extremities
5. Low blood pressure
6. Sunken eyes.
7. Very dry mouth,mucus membranes.
8. Infants will have sunken fontanels.
9. Shrivelled and dry skin which lacks
elasticity.

26. Management of
gastroeneritis.
According to(Integrated management of
child illnesses,IMCI)Protocol plan A,B
and C.
 Plan A;Management of the
dehydration.Fluid management.
A. Early dehydration.
a) Rehydration therapy is not required.
b) Replacement of losses.Less than
10kgs,give 60-120 oral dehydration
solution for each diarrhea stool or
vomiting episode.

27. Cntd,of early dehydration
managent.
More than 10kgs,body give 120-140mls
oral rehydration for each diarrhea
stool or vomiting episode.

28. B.Moderate dehydration.
 Rehydration therapy.Give oral
rehydration solution 50 to 100mls/kg
for 3 to hours.
 Replacement of losses.Less than
10kgs body weight,60 to 120mls oral
ryhydration solutions for each
diarrhea stool or vomiting episode.
 Those who are more than 10kgs, body
weight 120 to 140 mls,oral rehydration
solution for each diarrhea stool or
vomiting episode.

29. Severe dehydration
management.
 Rehydration therapy.Adminster
intravenous Ringers lactate or
N/S(20mls per kg)untill perfusion and
mental states improve,followed by
100ml/kg oral rehydration salution
over four hours,or 50% dextrose half
N/S intravenous at twice maintenance
rates.

30. Replacement therapy.
 10kgs,body weight 60 to 120mls oral
rehydration solution for dehydration
stool or vomiting episode.
 More than 10kgs body weight give 120
to 140 mls,oral rehydration solution for
each diarhea stool or vomiting
episode.
 If unable to drink adminster through
nasogastric tube or intravenously
adminster 5% dextrose on fourth
N/S,with 20mEq/L pottasium chloride.

31. Plan B;Medical management.
 Compylobacter spp,its treated with Erythromycin.
 Clostridium difficile,discontinue the causative
antibiotic.If antibiotics cant be stopped,oral
mentronidazole or vancomycin is adminstered.
 Entamoeba hystolytica;metronidazole followed by
iodoquimol,or paramomycin.
 E.coli;sulfamethoxazole in moderate
diarrhea,while third and fourth cephalosporin are
indicated for systemic complications.
 Zinc suplements are given to reduce severity of
diarrhea,10-20mg/day for 10-14 days for chidren
younger 5yrs.
 Don’t give antidiarrheal drugs.

32. Plan C;Nutritional
management.
 During rehydration therapy;
 Continue breast feeding.
 Don’t give solid foods.
 In children without flag symptoms and
signs,don’t routinely give oral fluids
other than ORS,however consider
supplementation with the childs
fluids;breast milk or water but not fruit
juices or carbonated drinks,if they
refuse the ORS solution.

33. Cntd,
 In children with red flag symptoms or signs,don’t
give oral fluids other than ORS SOLUTION.
 After rehydration;Give full-strength milk straight
away.
 Re-introduce the childs usual solid foods.
 Avoid giving fruit juices and carbonated drinks
until the diarrhea has stopped.
 NB;Not all commercial ORS formulas promote
optimal absorption of electrolytes,water and
nutrients.
 An ideal solution should have an osmolarity
of(210-250)and sodium content of 50-
60mmol/litre.
 WHO recomends use of the ORT form of ORS.

34. THANK YOU.
QUESTIONS.

35. END OF SLIDES SHOW.