CARE OF PATIENT WITH
ACUTE GASTROENTERITIS
WITH DEHYDRATION
LEARNING OBJECTIVES
General objectives:
At the end of the Case Presentation, the Learners shall improve their
understanding, increase their knowledge, enhance their independent
and collaborative skills and manifest desirable attitude in providing
immediate and holistic care to patients with Acute Gastroenteritis with
dehyration.
SPECIFIC OBJECTIVES
1.Identify what is Gastroenteritis.
2.Identify causes that can lead to Gastroenteritis
3.Understand terminilogies of diarrhea
4.Identify risk factors of Gastroentiritis
5.Identify signs and symptoms of Gastroenteritis.
6.Discuss the disease process and its pathophysiology effectively.
7.Identify and discuss its appropriate management effectively.
WHAT IS ACUTE GASTRO ENTERITIS?
• Gastroenteritis is inflammation (irritation) of your intestines. People
usually call it a “stomach bug” or “stomach flu,” even though it's not
limited to just influenza. Although most people report stomach pain,
gastroenteritis can also involve your small intestines and colon
• Infections that cause
gastrointestinal illness (GI) may
be caused by a variety of agents
including bacteria, viruses and
protozoa.
Infective Causes
• Viruses
• Bacteria
• Bacterial Toxins
Clarification of Terminology
Diarrhea: 3 or more loose stools or stools with increased liquid per day (as
defined by the WHO)
Acute diarrhea: Lasting less than 14 days
Chronic diarrhea: Lasting more than 14 days
Dysentery: Gastroenteritis characterised by loose stools with blood and
mucus
Travellers’ diarrhea: More than 3 loose stools commencing within 24 hours
of foreign travel, with or without cramps, nausea, fever, or
vomiting
Risk Factors
• Poor food preparation,
especially in handling and
cooking
• Immunocompromised
• Poor personal hygiene
Clinical Features
• Patients will typically present
with a cramp-like abdominal
pain and diarrhoea (with or
without blood or mucus). There
may be associated vomiting,
night sweats, and weight loss
reported. On examination, the
patient will often
be dehydrated (of varying
severity) with potential pyrexia.
Investigations
• Investigations are not necessary for most
cases, as the condition is usually self-
limiting. However, a stool culture is often
warranted, especially in cases with blood
or mucus in the stool, if the patient
is immunocompromised, or if severe or
persistent.
Management
• Rehydration, encouraging oral
fluid intake where possible
• If severe dehydration or unable to
tolerate oral fluid, the patient may
need admission for intravenous
fluid rehydration
• Education to prevent future
episodes
• Exclusion from work is usually 48
hours from the last episode of
vomiting or diarrhoea.
ANATOMY AND PHYSIOLOGY
• The gastrointestinal (GI) tract is
a hollow tube passing from the
mouth to the anus. There are
several names for the GI tract,
including the alimentary canal or
gut. The GI tract is about 7–11
metres long but appears shorter
due to the creases in the gut
wall. There are many organs
making up the GI tract:
The main function of the GI tract is to make ingested nutrients available
for the body to use. There are five main processes involved in the
functioning of the GI tract:
• Ingestion
• Propulsion
• Digestion
• Absorption
• Elimination.
Physiology of defecation
• As faeces begin to fill the rectum, the rectal wall stretches, which
sends an impulse to nervous centres in the spinal cord to initiate the
spinal defecation reflex. This results in the relaxation of the internal
anal sphincter, which allows a small quantity of faeces to pass into the
anus. The anus detects whether the material is gaseous or solid and
acts accordingly. If the material is solid, the external anal sphincter
opens up and defecation takes place. However, the external anal
sphincter is controlled by voluntary muscles, so it can be consciously
restrained to delay defecation until a more convenient time.
• Faeces are normally passed by contracting the rectal muscles, helped by a
voluntary procedure called Valsalva’s manoeuvre. This involves contracting
the diaphragm and abdominal wall muscles, which increases intra-
abdominal pressure and pushes faeces out of the rectum.
• If the nerves between the external anal sphincter and the defecation centre
in the medulla are damaged – as may be the case after a stroke, in multiple
sclerosis, or after spinal injury – the ability to suppress defecation may be
lost, resulting in faecal incontinence. Also, with ageing, the ability of the
anus to detect whether it contains gas or faeces may become impaired and
faecal matter may be treated as gas, causing faecal incontinence.
Disorder of the intestine
Diarrhoea
Diarrhoea (loose and watery stools) is most commonly caused by
gastroenteritis, norovirus or food poisoning but can also be due to food
intolerances or allergies, irritable bowel syndrome, inflammatory bowel disease,
coeliac disease and diverticular disease.
If the intestines do not absorb fluids, the body can lose several litres of fluid
per day, with consequences such as dehydration, loss of electrolytes (potassium
and sodium ions) and increased risk of blood clotting. Large losses of potassium
ions, for example, can cause cardiac arrest. The only absorption mechanism that is
not disturbed by diarrhoea is glucose/sodium co-transport, which means people
with diarrhoea can increase absorption of essential sodium and water in the
presence of glucose.
PATIENT’S PROFILE
Name: Patient X Admission Date: February 16, 2022
Age: 33 years old Admission Time: 12:47 AM
Gender: Male Attending Physician: Dr.
Civil Status: Married Chief Complaints: 2 days watery stool
Occupation: Farmer Final Diagnosis: Acute Gastroenteritis with
Address: Dabyak, Katipunan, Zamboanga dehydration
Del Norte
Date of Birth: February 26, 1989
Place of Birth: Katipunan, Zamboanga Del
Norte
Religion: Alliance
Nationality: Filipino
Ward: Medical Ward
LABORATORY RESULT
Interpretation:
Platelet count- Infection
