Viral gastroenteritis

See Acute gastroenteritis (peds) for pediatric patients

Background

• Most common cause of acute gastroenteritis (AGE)
• Viral gastroenteritis usually lasts <7d
• Do NOT diagnosis isolated vomiting as AGE!

Clinical Features

• Vomiting
• Watery, non-bloody diarrhea
• Crampy/diffuse abdominal pain
• Features that suggest non-viral etiology:
  • Bloody diarrhea (Salmonella, shigella)
  • RLQ pain (Yersina, Entamoeba)
  • Recent antibiotics + copious, foul diarrhea (C. Diff)
  • Consumption of previously cooked/reheated foods (especially meats, mayonaise, etc.)
  • Explosive, "rice-water" diarrhea (cholera)
  • bloating, really nasty flatus/stools (giardia)

Differential Diagnosis

Diffuse Abdominal pain

• Abdominal aortic aneurysm
  • Aortocaval fistula
• Acute gastroenteritis
• Aortoenteric fisulta
• Appendicitis (early)
• Bowel obstruction
  • Large bowel obstruction
    • Ogilvie's syndrome
  • Small bowel obstruction
• Bowel perforation
• Gastroparesis
• Diabetic ketoacidosis
• Inflammatory bowel disease
• Mesenteric ischemia
• Pancreatitis
• Peritonitis
• Sickle cell crisis
• Spontaneous bacterial peritonitis
• Volvulus

Nausea and vomiting

Critical

• ACS/MI
• Boerhaave's
• DKA
• Intracranial Hemorrhage
• Ischemic bowel
• Meningitis
• Sepsis

Emergent

• Acute radiation syndrome
• Acute gastric dilation
• Acetaminophen toxicity
• Adrenal insufficiency
• Appendicitis
• Aspirin toxicity
• Bowel obstruction/ileus
• Carbon monoxide poisoning
• Cholecystitis
• CNS tumor
• Digoxin toxicity
• Electrolyte abnormalities
• Elevated ICP
• Gastric outlet obstruction
• Hyperemesis gravidarum
• Pancreatitis
• Peritonitis
• Ruptured viscus
• Testicular torsion/ovarian torsion
• Theophyline toxicity

Nonemergent

• Biliary colic
• Cannabinoid hyperemesis syndrome
• Chemotherapy
• Disulfiram effect
• Erythromycin
• ETOH
• Gastritis
• Gastroenteritis
• Gastroparesis
• Hepatitis
• Ibuprofen
• Labyrinthitis
• Migraine
• Motion sickness
• Narcotic withdrawal
• Thyroid
• Pregnancy
• Peptic ulcer disease
• Renal colic
• UTI

Evaluation

• Assess hydration status
  • Cap refill, skin turgor, respiratory rate
• Consider stool studies if:
  • >10 stools in previous 24hr
  • Travel to high-risk country
  • Fever
  • Bloody stool
  • Persistent diarrhea

Management

1. Rehydration (PO preferred)
   • 30mL(1oz)/kg/hr
   • Reduced-osmolarity oral rehydration solution
2. Antiemetic
   • Ondansetron 0.15mg/kg/dose IV/PO
   • May worsen diarrhea

Disposition

• Most can be discharged

Admit

• Unable to tolerate PO
• Hemodynamic instability
• Significant comorbidities

See Also

• Acute gastroenteritis
• Nausea and Vomiting
• Acute gastroenteritis (peds)
• Dehydration
• Acute diarrhea

References

Authors

Claire, Ross Donaldson