Gastroenteritis

Commonly called as diarhhea.

acute infectious syndrome of the stomach lining and the intestine. It is
characterized by diarrhea, vomiting, and abdominal cramps. Other symptoms
nausea, fever & chills.
Varies severity of gastroenteritis : diarrhea
dehydration
Viruses
Bacteria
secreting toxins
gastroenteritis
Parasites
or directly invading
walls of gut

stimulate excessive water & e loss

trigger inflammation

loss balance

Viral gastroenteritis / viral diarrhea : most common in the world (rotavirus,

caliciviruses, norwalk & adenovirus)
Food poisoning, cholera and travelers diarhhea : develops within a few days
after traveling to a country or region that has unsanitary water and food.

Enteric (Typhoid) Fever

systemic disease characterized by fever and abdominal
pain and caused by dissemination of S. typhi or S.
paratyphi.
The disease was initially called typhoid fever because
of its clinical similarity to typhus.
In the early 1800s, typhoid fever was clearly defined
pathologically as a unique illness on the basis of its
association with enlarged Peyers patches and
mesenteric lymph nodes.
S. paratyphi A is thought to cause milder disease than
S. typhi, with predominantly gastrointestinal symptoms.

 symptoms reported on initial medical evaluation :

included headache (80%),

chills (3545%)
cough (30%)
sweating (2025%)
myalgias (20%),
malaise (10%)
arthralgia (24%).

Gastrointestinal manifestations :

anorexia (55%)
abdominal pain (3040%)
nausea (1824%),
vomiting (18%)
diarrhea (2228%) more commonly than constipation (1316%)

Physical findings
coated tongue (5156%),
splenomegaly (56%)
abdominal tenderness (45%)

 Early physical findings of

enteric fever include rash
(rose spots; 30%),
hepatosplenomegaly (3
6%), epistaxis, and relative
bradycardia at the peak of
high fever (<50%).

 Laboratory examination :

whole blood (commonly found leukopenia, mild anemia, trombositopenia)

Widal test
Typhidot test
IgM dipstick test
Blood Culture

Treatment :
Rest
Diet & adjunctive therapy
Antimicroba

Kloramfenikol
Tiamfenikol
Kotrimoksazol
Ampisilin & amoksisilin
Sefalosporin 3rd
Florokuinolon
azitromisin

Diarrhea
Diarrhea is loosely defined as passage of
abnormally liquid or unformed stools at an
increased frequency.
The augmented water content in the stools
(above the normal value of approximately
10 mL/kg/d in the infant and young child,
or 200 g/d in the teenager and adult)
Acute if <2 weeks, persistent if 24 weeks,
and chronic if >4 weeks in duration
Diarrhea with blood, mucous, tenesmus,
abdominal cramping & fever, called as
dysentery syndrom.

Acute Diarrhea
More than 90% of cases of acute diarrhea are caused by
infectious agents (fecal oral transmission, food or water
contaminated); these cases are often accompanied by vomiting,
fever, and abdominal pain.
The remaining 10% or so are caused by medications, toxic
ingestions, ischemia, food indiscretions, and other conditions (ex:
AB can lead diarrhea by allowing overgrowth of pathogens, such
as C.difficile).
Acute infection or injury occurs when the ingested agent
overwhelms or by passes the hosts mucosal immune and
nonimmune (gastric acid, digestive enzymes, mucus secretion,
peristalsis, and suppressive resident flora) defenses.

 DD :
Entamoeba histolytica : bloody diarrhea (referred to as
dysentery).
Yersinia invades the terminal ileal and proximal colon mucosa
and may cause especially severe abdominal pain with
tenderness mimicking acute appendicitis.
viral hepatitis
listeriosis
Legionellosis
toxic shock syndrom

 Examination :
microbiologic analysis of the stool (cultures for bacterial and
viral pathogens) such as immunoassays for certain bacterial
toxins (C. difficile), viral antigens (rotavirus), and protozoal
antigens (Giardia, E. histolytica).
If stool studies are unrevealing, flexible sigmoidoscopy with
biopsies and upper endoscopy with duodenal aspirates and
biopsies may be indicated.
Colonoscopy or CT-scan to exclude suspected noninfectious
diarrhea (ischemic colitis, diverticulitits, partial bowel
obstruction)

Treatment
Most episodes of acute diarrhea are mild and self-limited and not
need pharmacologic interventions.
Indications for evaluation :

profuse diarrhea with dehydration

grossly bloody stools
fever 38.5C (101F)
duration >48 h without improvement
recent antibiotic use
new community outbreaks
associated severe abdominal pain in patients >50 years, and elderly (70
years) or immunocompromised patients.

moderately severe febrile diarrhea associated with fecal leukocytes

or with gross blood, a diagnostic evaluation might be avoided in
favor of an empirical antibiotic trial.

 Fluid replacement alone may suffice for mild cases.

Oral sugar-electrolyte solutions (iso-osmolar sport drinks or
designed formulations) should be instituted promptly with
severe diarrhea to limit dehydration.
Dehydrated patients, especially infants and the elderly,
require IV rehydration.
antimotility and antisecretory (loperamide) : In moderately
severe nonfebrile and nonbloody diarrhea to control
symptoms
Bismuth subsalicylate may reduce symptoms of vomiting
and diarrhea & reduce the frequency of travelers diarrhea.
treat moderately to severely ill patients with febrile
dysentery empirically without diagnostic evaluation using a
quinolone, such as ciprofloxacin (500 mg bid for 35 d)

Chronic Diarrhea
most of the causes of chronic diarrhea are
noninfectious.
Chronic diarrhea according mechanism :

Secretory
Osmotic
Steatorrheal
Inflammatory causes
Dysmotile causes

Secretory causes
due to derangements in fluid and electrolyte transport across the
enterocolonic mucosa.
characterized clinically by watery, large-volume fecal outputs that are
typically painless and persist with fasting.
Chronic ethanol consumption may cause a secretory-type diarrhea due to
enterocyte injury with impaired sodium and water absorption as well as
rapid transit and other alterations.

Osmotic causes
ccurs when ingested, poorly absorbable, osmotically active solutes draw
enough fluid into the lumen to exceed the reabsorptive capacity of the colon
Ingestion of magnesium-containing antacids, health supplements, or
laxatives may induce osmotic diarrhea typified.
Carbohydrate malabsorption due to acquired or congenital defects in brushborder disaccharidases and other enzymes leads to osmotic diarrhea with a
low pH.

Steatorrheal causes
often associated with weight loss and nutritional deficiencies due
to concomitant malabsorption of amino acids and vitamins.
Intraluminal maldigestion cause pancreatic exocrine insufficiency.
Mucosal malabsorbtion cause celiac disease

Inflammatory causes
generally accompanied by pain, fever, bleeding, or other
manifestations of inflammation.
mechanism of diarrhea may release of cytokines and other
inflammatory mediators.
Crohns disease and chronic ulcerative colitis : most common
organic causes of chronic diarhhea in adults.
Immunodeficiency may lead to prolonged infectious diarrhea.

Dysmotility causes
Hyperthyroidism and certain drugs (e.g., prostaglandins,
prokinetic agents) may produce hypermotility

Treatment
Treatment of chronic diarrhea depends on the specific etiology
and may be curative, suppressive, or empirical.
For many chronic conditions, diarrhea can be controlled by
suppression of the underlying mechanism (eliminate dietary
lactose or gluten)
fluid and electrolyte repletion is an important component of
management.
Mild opiates, such as diphenoxylate or loperamide, are often
helpful in mild or moderate watery diarrhea.
For more severe diarrhea, codeine or tincture of opium may be
beneficial.

Dysentery
infection of the intestines that causes diarrhea containing blood or
mucus.
Other symptoms of dysentery can include:
painful stomach cramps
nausea or vomiting
a high temperature (fever) of 38C (100.4F) or above, or 37.5C (99.5F) or
above in children under five
nausea and vomiting
Watery diarrhea, which can contain blood, mucus orpus
painful passing of stools
fatigue
intermittentconstipation

Two main types of dysentery:

bacillary dysentery or shigellosis caused by shigella
bacteria; this is the most common type of dysentery
amoebic dysentery or amoebiasis caused by an amoeba
(single-celled parasite) called Entamoeba histolytica, that's
found mainly in tropical areas; this type of dysentery is usually
picked up abroad

Both type can passed to another human by food

contamination infected poo, someone doesnt wash
their hands and oral anal sex (gay).

 Treatment :
Rehidrasi therapy
If symptoms are not severe and the doctor determines it is
Bacillary dysentery(Shigella), the patient most likely will
receive no medication
If amoebic dysentery, antibiotic and amoebicidal drugs
(metronidazol, paromomicyn, iodoquinol)

Prevention :
Reduce risk of infection by regularly washing their hands,
especially before and after going to the toilet and preparing
the food.
If you are in an area where the risk of dysentery is higher, only
drink water from reliable sources (bottled water).
Make sure the food you eat is thoroughly cooked and beware
of ice cubes.

Reference
http://www.britannica.com/science/gastroenteritis
http://
emedicine.medscape.com/article/231135-overview#a5
http://
www.medicalnewstoday.com/articles/171193.php?page
=2
Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL,
Loscalzo J, editors. Harrisons Principle of Internal
Medicine. 19th ed. USA: McGraw-Hill; 2015.
Tanto C, Liwang F, Hanifati S, Pradipta EA, editors.
Kapita Selekta Kedokteran. Edisi 4. Jakarta: Media