1. Viral GASTROENTERITIS
By:
Dr. Yasir Hakim, MD Pathology& Microbiology.
Assistant Professor and Chairman
Department of Microbiology
College of Medicine
Dar Uloom –University – KSA
د. ياسر عبدالله – دكتوراة علم الأمراض والأحياء الدقيقة الطبية والطفيليات.
رئيس قسم الأحياء الدقيقة الطبية والطفيليات
اسم ورقم المقرر – Course Name and No.
4/22/2019

2. Def of viral gastroenteritis (stomach flu).
Inflammation of stomach or intestines inhibits nutrient absorption and excessive H2O and electrolyte loss & marked by watery diarrhea, abdominal cramps, nausea or vomiting, and sometimes fever
Bacterial
Viral
Parasites

3. Types

4. Causes of gastroenteritis

5. Common Bacterial pathogens
Campylobacter
Salmonella
Shigella
Yersinia
Pathogenic E.coli
Cause 10 – 15 % of diarrheal illness
Under developed nations consider vibrio species

6. Parasitic agents
Giardia intestinalis, Cryptosporidium parvum, Entamoeba histolytica, and Cyclospora cayetanensis most commonly cause acute diarrheal illness in children.
These agents account for a relatively small proportion of cases of infectious diarrheal illnesses among children in developing countries.

7. Viral Agents Rotavirus Norwalk virus Enteric Adenovirus Astrovirus
Gastroenteritis, 2002

8. Pathophysiology
The clinical manifestations for viral gastroenteritis are due to the effects that the viruses, along with specific cytotoxins, have on the enterocytes of the intestine.
The virus uses the enterocytes to replicate, leading to interference with brush border enzyme production, which in turn leads to malabsorption and osmotic diarrhea(  poorly absorbed solutes in the bowel lumen that inhibit normal water and electrolyte absorption).
Gastroenteritis, 2002

9. Risk factors
People who may be more susceptible to gastroenteritis include:
Young children. Children in child care centers or elementary schools .Schoolchildren, churchgoers or dormitory residents. Anywhere that groups of people come together in close quarters can be an environment for an intestinal infection to get passed.
Older adults. Adult immune systems tend to become less efficient later in life.
Anyone with a weakened immune system. If your resistance to infection is low — for instance, if the immune system is compromised by HIV/AIDS, chemotherapy or another medical condition —
Gastroenteritis, 2002

10. Clinical Presentation: Symptoms
Nausea / Vomiting
Cramping abdominal pain
Increased peristalsis
Absence of blood(non bloody) and fecal Leukocytes
Key to differential with bacterial infections
Gastroenteritis, 2002

11. Physical Signs Non-bloody Stools
Dehydration(tested by skin turgor sign is skin's elasticity commonly on the lower arm or abdomen is checked)
Decreased urination
Mental status changes
Dry mucous membranes
Lethargy
Gastroenteritis, 2002

12. اسم ورقم المقرر – Course Name and No.
4/22/2019

13. Gastroenteritis, 2002

14. Diagnostic Testing Focused Bloody diarrhea? Fecal leukocytes?
If non-inflammatory, no culture
Lab Tests?
Viral Detection?
Test for rotavirus
Gastroenteritis, 2002

15. Management Self limiting course Replace fluids and electrolytes
Oral Rehydration (ORT)- ORS
Commercially available ORT
Pedialyte (45 meq Na )
Ricelyte (50 meq Na )
Gastroenteritis, 2002

16. اسم ورقم المقرر – Course Name and No.
4/22/2019

17. Management Severe Dehydration ORT can be successful IV fluids Shock
Uremia
Fluid loss > 10 ml/kg/hr
Gastroenteritis, 2002

18. Refeeding ORT: continue during diarrhea Continue breast feeding
Formula fed :
Lactose free
Gastroenteritis, 2002

19. Antidiarrheal Agents Anticholenergic agents Ineffective
Contraindicated in children
Absorbents agents
Kaopectate
Gastroenteritis, 2002

20. Antidiarrheal Agents Anti-motility Agents Loperimide Lomotil
Gastroenteritis, 2002

21. Vaccination
RotaTeq® (RV5) vaccine is given in 3 doses at ages 2 months, 4 months, and 6 months.
Rotarix® (RV1) is given in 2 doses at ages 2 months and 4 months
Gastroenteritis, 2002

22. Reference
Henley, C.E., Gastroenteritis. Manual of Family Practice. Taylor, Robert B., Little, Brown, 2nd Edition,
Gastroenteritis, 2002

23. مع امنياتى لكم بالتوفيق
د. ياسر عبدالله حاكم
اسم ورقم المقرر – Course Name and No.
4/22/2019