Infectious gastroenteritis (acute) (pediatrics): Clinical sciences

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Acute infectious gastroenteritis refers to an infection of the stomach and intestines that has a rapid onset and lasts 2 weeks or less. Gastrointestinal infections typically present with vomiting and diarrhea after fecal-oral contact or ingestion of contaminated food or water. Most cases of acute infectious gastroenteritis are caused by either viral or bacterial pathogens.

Now, if a pediatric patient presents with a chief concern suggesting acute infectious gastroenteritis, first perform an ABCDE assessment to determine if they are unstable or stable.

If unstable, stabilize their airway, breathing, and circulation. Obtain IV access, start IV fluids, and consider administering a fluid bolus. Next, begin continuous vital sign monitoring, including heart rate, respiratory rate, blood pressure, and pulse oximetry; provide supplemental oxygen if needed; and consider starting antibiotics.

Now that we’ve discussed unstable patients, let’s return to the ABCDE assessment and take a look at stable patients.

Start by obtaining a focused history and physical examination.

History typically includes the acute onset of diarrhea, vomiting, anorexia, and abdominal cramps lasting 2 weeks or less. Some patients also report a fever or a sick contact.

Physical exam may demonstrate abdominal tenderness and hyperactive bowel sounds, but in more severe cases, you might see signs of dehydration, like decreased skin turgor, sunken eyes, and dry mucous membranes.

These findings are highly suggestive of acute infectious gastroenteritis.

Next, assess whether there are indications for obtaining a stool culture. These include outbreaks in a childcare setting or school; exposure to animals or contaminated food; blood or mucus in the stool; or recent foreign travel. Additionally, any young or immunocompromised patient with a high fever should have stool sent for culture.

Now, if there’s no indication for a stool culture, you should suspect viral gastroenteritis, which is commonly caused by rotavirus, norovirus, or adenovirus.

Sources

  1. "2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea." Clinical Infectious Diseases. (2017;65(12):e45-e80. )
  2. "Acute gastroenteritis. " Pediatr Rev. (2012;33(11):487-495.)
  3. "Gastroenteritis in Children [published correction appears in Am Fam Physician. 2019 Jun 15;99(12):732]. " Am Fam Physician. (2019;99(3):159-165.)
  4. "Nelson Textbook of Pediatrics. 21st ed. " Elsevier; (2020. )
  5. "Nelson Essentials of Pediatrics. 8th ed. " Elsevier; (2023. )