[Clinical Notes] Gastroenteritis: How To Take History

The word Gastroenteritis or Stomach Flu is made of two- Gastro: Stomach, Enteri: Intestines, and Itis: Inflammation. Therefore, Gastroenteritis is inflammation of the gastrointestinal tract involving the Stomach and Intestines. It is indeed one of the common symptoms in people, but dangerous in children and babies, as it can cause severe complications.

Today we are going to uncover the question-answers approach towards Gastroenteritis and the Difference between Bacterial and Viral Gastroenteritis while also dealing with the causes, signs, and symptoms of gastroenteritis.

Gastroenteritis can be caused by a number of pathogens, involving the main categories as Viruses (Viral gastroenteritis), Bacteria (Bacterial gastroenteritis), Parasites (Parasitic gastroenteritis), and finally, Fungus (Fungal gastroenteritis). The following table explains the causes of Gastroenteritis in a more detailed fashion:

Causes

1. Virus
2. Bacteria
3. Parasite
4. Fungus

Viral Gastroenteritis Causes

These can include the following:

• Rotavirus (common in < 5-year-olds)
• Norovirus (common at all ages)
• Sapovirus (common in <5 years)
• Astrovirus (common in <5 years)
• Adenovirus (common in <5 years)

Bacterial Gastroenteritis Causes

These can include the following:

• Campylobacter jejuni
• E.coli (Traveller’s diarrhea)
• Salmonella
• Shigella
• Vibrio cholerae
• Staphylococcus Aureus
• Clostridium difficile

Parasitic Gastroenteritis Causes

These can include the following:

• Giardia lamblia
• Entamoeba histolytica

Fungal Gastroenteritis Causes

These can include the following:

• Candida spp (candiasis)
• Histoplasmosis capsulatum (histoplasmosis)
• Mucorales spp (mucormycosis)
• Paracoccidioides brasiliensis (South American blastomycosis)

Difference between Bacterial and Viral Gastroenteritis

Clinical Features

Signs and Symptoms

Gastroenteritis or Stomach flu presents as following symptoms:

1. Vomiting
2. Diarrhoea
3. Abdominal cramps
4. Lasts around 1-7 days at max
5. Start around (Gastroenteritis Incubation period) 12-72 hours of ingestion of contaminated food
6. Associated symptoms include Headache, Fever, Chills, and Myalgia (muscle pain)

Following Bristol Stool Chart can always help in assessing Diarrhea:

Bristol Stool Chart

Clinical approach through Questions

The clinical approach to patients with gastroenteritis is made through sets of questions which are as follows:

• QUESTION 1: What are the C/C (Chief complaints) or symptoms of the patients?
• QUESTION 2: What is the onset of symptoms?
• QUESTION 3: What is the duration of symptoms? (more than 4 weeks is Chronic gastroenteritis; less than 4 weeks is Acute gastroenteritis)
• QUESTION 4: Is there any diarrhea? (Follow the history of diarrhea)
• QUESTION 5: Is there blood or mucus in diarrhea?
• QUESTIONS 6: Has the patient traveled anywhere recently? (Traveler’s diarrhea)
• QUESTION 7: Is there any Fever? (Follow History taking for Fever)
• QUESTION 8: What is the frequency of stool? (Remember there is a definition of diarrhea too: three or more loose or liquid stools per day)
• QUESTION 9: If diarrhea is bloody, then is there any pain in the right lower quadrant? (it can clue towards Crohn’s disease)
• QUESTION 10: Are the signs of dehydration present? (Skin turgor and sunken eyes are common)
• QUESTION 11: What is the drug/medicine history? (To rule out immuno-compromised patients)
• QUESTION 12: Is there any urge to pass stools (Also known as tenesmus)

BONUS TIPS:

1. Old patients with constipation followed by diarrhea are having Spurious Diarrhea.
2. If chronic diarrhea (more than 4 weeks), then check for tenderness or fever. If it is present, then it is Inflammatory Bowel Disease or IBD, if absent, then it is Malabsorption.

See the Video!

The following video will help understand things better :

Source: Khan Academy