[Clinical Notes] Gastroenteritis: How To Take History

Gastroenteritis or Stomach Flu, is made of two words- Gastro: Stomach, Enteri: Intestines and Itis: Inflammation. Therefore, Gastroenteritis is inflammation of gastrointestinal tract involving 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 Difference between Bacterial and Viral Gastroenteritis while also dealing with causes, signs and symptoms of gastro-enteritis.

Gastroenteritis can be causes by a number of pathogens, involving the main categories as Viruses (Viral gastroenteritis), Bacteria (Bacterial gastroenteritis), Parasites (Parasitic gastroenteritis) and finally, Fungus (Fungal gastroenteritis). Following table explains the causes of Gastroenteritis in 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
• Stahylococcus Aureus
• Clostridium difficile

Parasitic Gastroenteritits 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

Feature	Viral	Bacterial
Setting	Developed/Developing country	Poor hygiene and sanitation
Season	Winter	Summer
Incubation period	1-3 days usually	1-7 days commonly, few hours maybe (Staph. Aureus)
Fever	Common with Rotavirus and Norovirus	Common with Diarrhea (Salmonella and Shigella)
Vomitting	Very common, espeically in children	Uncommon with diarrhea
Duration	1-3 days: Norovirus,Sapovirus 2-8 days: Others	1-2 days: Toxins producing bacteria 2-8 days: Others
Diagnosis	Diagnosis of exclusion Electron microscopy (EM) or Enzyme Immunoassay (EIA)	Stools: Leucocytes and blood Culture of stools for bacterial growth Total Leucocyte Count (TLC) or Differential Leucocyte Count (DLC) of blood
Treatment	Only Supportive treatment Anti-motility drugs and Anti-bacterials are contradicted	Anti-biotics Suportive treatment
Diarrhea	Common Non-bloody in all cases	Prominent Blood-stained

 

Clinical Features

Signs and Symptoms

Gastro-enteritis 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 the Diarrhea:

Bristol Stool Chart

 

Clinical approach through Questions

Clinical approach to patient of 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 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 definition of diarrhea too: three or more loose or liquid stools per day)

QUESTION9: If diarrhea is bloody, then is there any pain in 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. Chronic diarrhea (more than 4 weeks), then check tenderness or fever. If it is present, then it is Inflammatory Bowel Disease or IBD, if absent, then it is Mal-absorption.

See the Video!

Following video will help understand things better :

Source: Khan Academy