ACUTE GASTROENTERITIS

A. DEFINITION
Acute gastroenteritis refers to a sudden onset of inflammation, irritation, or infection of the gastrointestinal tract,
which includes the stomach and the intestines. This condition is commonly characterized by symptoms such as
diarrhea, vomiting, abdominal cramps, and sometimes fever. The term "acute" implies a rapid onset of
symptoms, and "gastroenteritis" specifically refers to inflammation of the stomach (gastro-) and intestines (-
enteritis).
The most common causes of acute gastroenteritis are viral or bacterial infections, although it can also be
triggered by parasites or toxins. Viruses like norovirus and rotavirus, as well as bacteria such as Salmonella,
Escherichia coli (E. coli), and Campylobacter, are frequent culprits. Contaminated food or water, poor hygiene
practices, and close contact with infected individuals are common ways the infection can spread.

B. ANATOMY AND PHYSIOLOGY (only of the major organ involved)

Acute gastroenteritis primarily affects the gastrointestinal (GI) tract, which is a complex system responsible for
the digestion and absorption of nutrients, as well as the elimination of waste. The major organs involved in the
GI tract include the stomach, small intestine, and large intestine (colon).
NORMAL:
The gastrointestinal system is responsible for digestion and absorption of nutrients. The major organs involved
in the gastrointestinal tract include the stomach and intestines. The stomach secretes gastric juices, while the
small intestine absorbs nutrients, and the large intestine reabsorbs water and electrolytes.
Stomach
- The stomach is a muscular organ located in the upper abdomen. It has three main parts: the fundus, body,
and antrum. The stomach secretes gastric juices containing enzymes and acids to break down food.
- Mechanical churning and chemical digestion of food occur in the stomach. The partially digested food, known
as chyme, is released into the small intestine.

Small Intestine
- The small intestine is a long, coiled tube consisting of three segments: the duodenum, jejunum, and ileum. It
is where most nutrient absorption takes place.
- Digestive enzymes from the pancreas and bile from the liver further break down chyme in the small intestine.
Nutrients are absorbed through the intestinal lining into the bloodstream.

Large Intestine (Colon)

- The large intestine is responsible for absorbing water and electrolytes, forming and storing feces. It consists
of the cecum, colon, rectum, and anus.
- The remaining indigestible material from the small intestine passes into the colon, where water is absorbed,
and the material is formed into feces. The colon also houses a large population of beneficial bacteria.
WITH THE CONDITION:
In acute gastroenteritis, inflammation disrupts normal digestive processes, leading to increased fluid secretion,
impaired absorption, and altered motility, resulting in diarrhea and vomiting.
Stomach
Inflammation of the stomach lining can occur, leading to increased secretion of fluids and mucus. This results
in symptoms such as nausea, vomiting, and abdominal pain.

Small Intestine
Infections, often viral or bacterial, can cause inflammation of the small intestine. This inflammation impairs the
normal absorption of nutrients and water, leading to diarrhea and dehydration.

Large Intestine (Colon)

Infections can also affect the colon, leading to increased motility and water loss. This contributes to the watery
consistency of diarrhea associated with gastroenteritis.

C. ETIOLOGY
Common causes of acute gastroenteritis include viral infections (such as norovirus and rotavirus), bacterial
infections (like Salmonella and Escherichia coli), and parasitic infections (such as Giardia lamblia).
Contaminated food or water, poor hygiene practices, and close person-to-person contact are common routes
of transmission.
Precipitating Factors Implication
Contaminated Food and Water Consuming food or water contaminated
with pathogens is a common route of
 infection.
Raw or Uncooked Food: Increases the
risk of bacterial and parasitic infections.
Person-to-Person Transmission Direct contact with an infected person or
surfaces contaminated with infectious
agents, especially in settings like
households, healthcare facilities, or
childcare centers, can facilitate the
spread of AGE.
Poor Sanitation and Hygiene Lack of proper hygiene and sanitation,
including inadequate handwashing,
improper disposal of feces, and
unsanitary living conditions, increases
the risk of exposure to infectious agents.
Predisposing Factors Implication
Age (young children and the elderly are Children: Infants, young children, and the
more susceptible) elderly are more vulnerable to
gastroenteritis due to underdeveloped or
weakened immune systems, reduced
gastric acidity in infants, and age-related
changes in the gastrointestinal tract.
Particularly susceptible, especially to viral
gastroenteritis like rotavirus.
Elderly: Weakened immune system and
comorbidities increase vulnerability.
Weakened Immune System Individuals with compromised immune,
such as those with HIV/AIDS, undergoing
chemotherapy, or on immunosuppressive
medications, are at increased risk of
severe and prolonged gastroenteritis due
to compromised ability to fight off
infections.

D. SYMPTOMATOLOGY (significant features/manifestations)

Significant features of acute gastroenteritis include diarrhea, often watery and frequent; vomiting; abdominal
cramps; nausea; fever; and dehydration. The severity of symptoms may vary, with complications such as
electrolyte imbalances, especially in vulnerable populations like infants and the elderly.
Symptoms Rationale
Diarrhea Inflammation of the intestines impairs
Significant Feature: Frequent, loose, water absorption, leading to increased
watery stools. fluid content in the stool.
Vomiting Irritation of the stomach lining and
Significant Feature: Forceful expulsion of nervous system triggers the vomiting
stomach contents. reflex.
Abdominal Cramps Inflammation and muscle contractions in
Significant Feature: Sharp or dull pains in the intestines contribute to abdominal
the abdomen. discomfort.
Fever Inflammatory responses triggered by the
Significant Feature: Elevated body infection can lead to fever as a systemic
temperature. reaction.

E. GENERAL PATHOPHYSIOLOGY (simplified)

Infectious agents disrupt the normal functioning of the intestinal mucosa, causing inflammation and damage.
This leads to an increased secretion of fluids into the intestines and decreased absorption, resulting in
diarrhea. Vomiting may occur as a protective mechanism to expel the offending agents.
PREDISPOSING FACTORS: PRECIPITATING FACTORS:
- Age - Contaminated Food and
Water
- Weakened Immune
System - Person-to-Person
Transmission
-Poor Sanitation and
Hygiene

INFLAMMATION OF THE
GASTROENTESTINAL TRACT

SIGNS/SYMPTOMS:

- DIARRHEA
 IMPAIRED
ABSORPTION - VOMITING

 INCREASED - ABDOMINAL
PERISTALSIS CRAMPS

 ACTIVATION OF THE - FEVER

ENTERIC NERVOUS
SYSTEM

F. MEDICAL MANAGEMENT
1. Fluid Replacement - Rehydration is crucial to replace fluids lost through diarrhea and vomiting, preventing
dehydration. Oral rehydration solutions (ORS) or intravenous fluids may be used based on the severity of
dehydration.
2. Antiemetic Medications - To control vomiting and improve tolerance of oral rehydration, antiemetic
medications may be prescribed in severe cases.
3. Antidiarrheal Medications (Caution) - While generally not recommended in infectious diarrhea, in certain
cases, antimotility agents may be used cautiously to alleviate symptoms. However, they are avoided in
bacterial or parasitic infections.
4. Nutritional Support - Maintaining nutrition is important. If tolerated, a normal diet can be resumed
gradually. In severe cases, a healthcare provider may recommend a temporary switch to a bland or easily
digestible diet.
5. Antibiotics (Select Cases) - Antibiotics may be prescribed in specific cases, such as bacterial
gastroenteritis. However, they are not routinely recommended and should be used judiciously to avoid
contributing to antibiotic resistance.
6. Probiotics - Probiotics, containing beneficial bacteria, may help restore the balance of the gut microbiota,
promoting a faster recovery.
7. Symptomatic Treatment (Fever, Pain) - Analgesics and antipyretics may be used to alleviate fever and
discomfort, enhancing patient comfort during recovery.
8. Isolation and Hygiene Measures - To prevent the spread of infectious agents, proper hygiene practices,
including handwashing and isolation precautions, are crucial.

G. LABORATORIES (2-3)
- Stool Culture: Detects the presence of bacteria in the stool, helping identify the causative agent.
- Complete Blood Count (CBC): Assesses for leukocytosis, indicative of infection or inflammation.
- Electrolyte Panel: Monitors electrolyte levels, especially sodium and potassium, to guide appropriate fluid
replacement.

H. MEDICATIONS (2-3)
- Antiemetics (e.g., Ondansetron): To alleviate nausea and vomiting, improving the patient's ability to tolerate
oral rehydration.
- Antibiotics (e.g., Ciprofloxacin): Prescribed in bacterial gastroenteritis cases to target the specific
pathogen.
- Antiparasitic Medication (e.g., Metronidazole): Used when parasitic infection is identified.

I. TREATMENT (if applicable, the surgery)

In severe cases with complications or persistent symptoms, surgical intervention is typically not required, and
the focus remains on supportive care and symptom management.

J. NURSING MANAGEMENT (5)

1. Fluid Monitoring: Monitor intake and output closely to ensure adequate hydration and detect signs of
dehydration early.
2. Infection Control: Implement strict hygiene measures to prevent the spread of the infectious agent.
3. Nutritional Support: Gradual reintroduction of a bland diet to promote healing and minimize gastrointestinal
irritation.
4. Pain Management: Administer analgesics as prescribed to alleviate abdominal cramps and discomfort.
5. Patient Education: Educate the patient on proper hand hygiene, food safety, and the importance of
completing any prescribed medications.

K. POSSIBLE NURSING DIAGNOSIS (3)

1. Fluid Volume Deficit related to diarrhea and vomiting, secondary to acute gastroenteritis.
Nursing Intervention
2. Risk for Imbalanced Nutrition: Less than Body Requirements related to nausea and decreased oral intake.
3. Knowledge Deficit related to home care management of gastroenteritis.
L. PROGNOSIS
Good Prognosis - The prognosis for acute gastroenteritis is generally favorable with appropriate medical
management. Most cases resolve within a few days to a week.
However, the prognosis may be influenced by factors such as the patient's overall health, age, and the
presence of underlying medical conditions. Complications such as severe dehydration can affect the
prognosis, emphasizing the importance of early intervention and supportive care.