I.

Definition

Gastroenteritis (also known as gastric flu or stomach flu, although

unrelated to influenza) is inflammation of the gastrointestinal tract, involving
both the stomach and the small intestine and resulting in acute diarrhea. It can
be transferred by contact with contaminated food and water. The inflammation
is caused most often by an infection from certain viruses or less often
by bacteria, their toxins, parasites, or an adverse reaction to something in the
diet or medication.

Acute gastroenteritis is quite common among children, though it is certainly

possible for adults to suffer from it as well. While most cases
of gastroenteritis last a few days, acute gastroenteritis can last for weeks and
months.

II. Anatomy and physiology

The GIT is composed of two general parts, the main GIT start from the mouth
to oesophagus, to Stomach to Small intestine to Large intestine to Rectum.

The oesophagus, stomach, large and small intestine, aided by the liver,
gallbladder and pancreas convert the nutritive components of food into energy
and break down the non-nutritive components into waste to be excreted.

The mouth

Anatomy

• Contains the lips, cheeks, palate, tongue, teeth, salivary

Glands, masticators/facial muscles and bones.
• Anteriorly bounded by the lips.

Physiology

• Important for the mechanical digestion of food

• The saliva contains SALIVARY AMYLASE or PTYALIN that
Starts the INITIAL digestion of carbohydrates

The Esophagus

Anatomy

• A hollow muscular tube

• Length- 25 cm
• Located in the mediastinum, anterior to the
spine, posterior to the trachea and heart
• The upper third contains skeletal muscles, contains the
upper esophageal or hypopharyngeal sphincter
• The lower third contains smooth muscles and the
esophago-gastric/ cardiac sphincter is found here

Physiology

• Functions to carry or propel foods from the oropharynx

to the stomach
The Stomach

Anatomy

• J-shaped organ in the LUQ

• Contains four parts- the fundus, the cardia, the body and
The pylorus
• The cardiac sphincter prevents the reflux of the contents
Into the oesophagus (entrance)
• The pyloric sphincter regulates the rate of gastric
Emptying into the duodenum (exit)
• Capacity is 1,500 ml

Physiology

• The functions of the stomach are generally to digest the

Food (proteins) and to propel the digested materials into
The SI for final digestion

The Small intestine

Anatomy

• Grossly divided into the Duodenum (proximal), Jejunum (middle) and

Ileum (distal).
• Longest segment, about 2/3 of the total length

Physiology

• The intestinal glands secrete digestive enzymes that

Finalize the digestion of all foodstuffs.
The large intestine

Anatomy

• Approximately 5 feet long

Parts:
1. The cecum- widest diameter, prone to rupture
2. The appendix
3.The ascending colon
4.The transverse colon
5.The descending colon
6. The sigmoid- most mobile, prone to twisting
7. The rectum
8. The Anus

III. PATHOPYSIOLOGY

Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites.

Food that has spoiled may also cause illness. Certain medications and
excessive alcohol can irritate the digestive tract to the point of inducing
gastroenteritis. Regardless of the cause, the symptoms of gastroenteritis
include diarrhea, nausea and vomiting, and abdominal pain and cramps.
Sufferers may also experience bloating, low fever, and overall tiredness.
Typically, the symptoms last only two to three days, but some viruses may last
up to a week.

The greatest danger presented by gastroenteritis is dehydration. The loss of

fluids through diarrhea and vomiting can upset the body's electrolyte balance,
leading to potentially life-threatening problems such as heart beat
abnormalities (arrhythmia). The risk of dehydration increases as symptoms are
prolonged. Dehydration should be suspected if a dry mouth, increased or
excessive thirst, or scanty urination is experienced.
If symptoms do not resolve within a week, an infection or disorder more
serious than gastroenteritis may be involved. Symptoms of great concern
include a high fever (102° F [38.9°C] or above), blood or mucus in the
diarrhea, blood in the vomit, and severe abdominal pain or swelling. These
symptoms require prompt medical attention.

IV. SIGNS AND SYMPTOMS

 Diarrhea

Explanation:
The epithelium of the digestive tube is protected from insult by a number
of mechanisms
constituting the gastrointestinal barrier, but like many barriers, it can be
breached. Disruption of
the epithelium of the intestine due to microbial or viral pathogens is a very
common cause of diarrhea in all species. Destruction of the epithelium results
not only in exudation of serum and blood into the lumen but often is
associated with widespread destruction of absorptive epithelium. In such
cases, absorption water occurs very inefficiently and diarrhea results.

 Abdominal pain or cramp

Explanation:
The pain associated with obstruction of a hollow viscous (as opposed to
peritoneal and solid organ pain) is often intermittent or "colicky", coinciding
with the peristaltic waves of the organ. Such cramps are exactly what is
experienced with early acute appendicitis and gastroenteritis and are
somewhat relieved by writhing and massage.

 Vomiting

Explanation:
Vomiting in diarrhea can occur when the lining of the intestines or
stomach is irritated by an infection. Usually the infection is caused by a virus
or bacteria. Diarrhea and vomiting can drain water and salts from the patient.
These need to be replaced to prevent the patient from becoming dehydrated.

Other Signs and Symptoms

 Nausea and vomiting

 Diarrhea
 Loss of appetite
 Fever
 Headaches
 Abnormal flatulence
 Abdominal pain
 Abdominal cramps
 Bloody stools (dysentery - suggesting infection by
amoeba, Campylobacter, Salmonella, Shigellaor some pathogenic strains
of Escherichia coli)
 Fainting and Weakness
 Heartburn

V. RISK FACTORS

• Improperly prepared foods or contaminated water and travel or

residence in areas of poor sanitation.

VI. MEDICATION

• Antiemetic - drugs may be helpful for vomiting in children.

• Antibiotics – sometimes used if symptoms are severe such as
dysentery.
• Antimotility agent
VII. Diagnostic Tests

Diagnosis relies on identification of the causative agent through.

• Stool and blood cultures, Gram’s stain, and direct swab rectal cultures.

Other laboratory test

• Complete blood count

• Electrolytes
• Kidney function test

VIII. Clinical Assessment

The evaluation of the child with symptoms of acute gastroenteritis begins with
a careful history to elicit information that might point to other illnesses with
similar presentations. Respiratory symptoms such as cough, dyspnea or
tachypnea may indicate the presence of an underlying pneumonia. Urinary
frequency, urgency or pain may be symptoms of pyelonephritis, an earache
may be a symptom of acute otitis media, and high fever and altered mental
status may be signs of meningitis or sepsis. Factors such as travel to
underdeveloped countries, exposure to untreated drinking or washing water
sources, contact with animals or birds, day care center attendance, recent
antibiotic treatment or even a recent change in diet may suggest other
specifically treatable causes of vomiting and diarrhea.

A second goal of the history is to assess the severity of the symptoms and the
risk of complications such as dehydration. The presence or absence of fever,
the amount and type of oral intake, and the frequency and estimated volume
of emesis or stool are important factors to consider. Fever increases insensible
water loss. Emesis, stool and urine volume in excess of intake invariably leads
to significant dehydration. Stool characteristics such as the presence of blood
should prompt consideration of inflammatory bacterial disease and a much
more aggressive work-up and intervention. Clinical signs may also be used to
classify the patient's dehydration as mild, moderate or severe.

Management of Dehydration

The management of acute gastroenteritis is directed at preventing or treating

the dehydration that so often accompanies this disease. These
recommendations are based on two major conclusions:

1. Oral rehydration therapy should be the initial treatment because

it is as effective as intravenous therapy in rehydrating and replacing
electrolytes in children with mild to moderate dehydration.
 2. An age-appropriate diet should be continued in children with
diarrhea who are not dehydrated, and an age-appropriate diet should
be resumed as soon as rehydration is accomplished in children with
mild to moderate dehydration.

Severe Dehydration

Intravenous therapy is usually reserved for use in children with severe

dehydration, which is marked by the presence of shock or near-shock. Signs of
hemodynamic instability, including profound lethargy, markedly delayed
capillary refill and tachycardia with severe orthostatic blood pressure changes,
represent a medical emergency and require immediate and aggressive
intravenous therapy to restore intravascular volume.

Management

Gastroenteritis is usually an acute and self-limited disease that does not

require pharmacological therapy. The objective of treatment is to replace lost
fluids and electrolytes. Oral rehydration is the preferred method of replacing
these losses in children with mild to moderate dehydration. Metoclopramide
and ondansetron however may be helpful in children.

Rehydration

The primary treatment of gastroenteritis in both children and adults is

rehydration, i.e., replenishment of water and electrolytes lost in the stools. This
is preferably achieved by giving the person oral rehydration therapy (ORT)
although intravenous delivery may be required if a decreased level of
consciousness or an ileus is present. Complex-carbohydrate-based Oral
Rehydration Salts (ORS) such as those made from wheat or rice have been
found to be superior to simple sugar-based ORS.

Sugary drinks such as soft drinks and fruit juice are not recommended for
gastroenteritis in children under 5 years of age as they may make the diarrhea
worse. Plain water may be used if specific ORS are unavailable or not
palatable.

Diet

It is recommended that breastfed infants continue to be nursed on demand

and that formula-fed infants should continue their usual formula immediately
after rehydration with oral rehydration solutions. Lactose-free or lactose-
reduced formulas usually are not necessary. Children receiving semisolid or
solid foods should continue to receive their usual diet during episodes of
diarrhea. Foods high in simple sugars should be avoided because the osmotic
load might worsen diarrhea; therefore substantial amounts of soft drinks, juice,
and other high simple sugar foods should be avoided. The practice of
withholding food is not recommended and immediate normal feeding is
encouraged. The BRAT diet (bananas, rice, applesauce, toast and tea) is no
longer recommended, as it contains insufficient nutrients and has no benefit
over normal feeding.

IX. NURSING HEALTHY MEASURES

Patient will maintain current body weight +/- 3 lbs over the course of her
hospital stay.

Interventions:

=> Weigh on admission and then weigh daily.

= >RD Consult for Diet and Nutrition Counselling

= >Monitor Food and Fluid Intake

= >Keep MD Informed of any weight loss

= >Maintain accurate intake and output

= >observe for skin turgor, dryness of skin and mucous membrane pain.

= >Assess degree of dehydration

= >Administered IV fluids as indicated and regulated as prescribed rate.

= >Encouraged to properly sterilize water.

= >Washed hands before and after each care activity.

= >Reduces risk of cross contamination.

X. POSSIBLE NURSING DIAGNOSIS

=>Acute pain related to inflammatory process.

=>Deficient fluid volume related to excessive loose through

normal routes AEB frequent passage of loose watery stool.

=>Activity in tolerance related to generalized weakness AEB

limited physical activity.

=>Imbalance nutrition: less than body requirement due to

insufficient intake and excessive output.

=>Risk for deficient fluid volume

=>Hyperthermia related to inflammatory process.