Gastroenteritis
Introduction
Gastroenteritis
is an infection of the gut (stomach and intestines). It can cause diarrhea,
vomiting and tummy ache. Diarrhea is a condition where the patient passes
watery stools more than the usual number of times for a day. In most patients
the infection clears within a few days, but sometimes takes longer. The main
risk of gastroenteritis is dehydration. When there is blood and mucus in
diarrhea it is a more serious condition and it is dealt separately as
dysentery.
Causative
agents - A large number of organisms can cause diarrhea. Rota virus is the
commonest cause in Sri Lanka. Bacteria like E.Coli, Salmonella, protozoa and
whip worms can also give rise to diarrhea.
Organisms
can enter the body through the mouth. Eating contaminated food, drinking
unclean water, through insects like flies and by contaminated hands can lead to
diarrhea. These organisms and their toxins damage the lining of the gut. This
will allow a large amount of water and salts to be lost with stool leading to
dehydration.
Symptoms
of gastroenteritis include diarrhea, vomiting and abdominal pain. Sometimes
fever may develop.
Signs
of dehydration are:
·
Thirst
·
Reduction of urine output
·
Dry tongue
·
Tears absent when crying
·
In infants a depression is formed in the soft area on top of the
skull (anterior fontanelle)
·
Loss of elasticity of skin – when the skin is pinched usually it
goes back rapidly but when there is dehydration it goes back slowly
When
there is severe dehydration the patient becomes restless or weak. Breathing
become rapid and hands and feet get cold and clammy. They can get drowsy or
even semi-conscious. You should take your child to the nearest hospital if
dehydration is getting worse.
Water
and electrolytes lost during diarrhea should be replaced. Continue breast
feeding and feeding with easily digestible nutritious food to maintain
nutritional status. Giving your child rice kanji, pori kanji, yogurt, anamalu
in addition to usual meals will help. If giving formula you should make it to
half strength.
Give
the child lots of fluids like king coconut water, young coconut water
(kurumba), lime juice and soup. Sweetened artificial fruit drinks can make
diarrhea worse.
Encourage
the child to eat much as he wants. Mothers may withhold food thinking that this
may stop the diarrhea. But it is very important to feed the child to prevent
malnutrition. Small frequent feedings are the best. Avoid bulky, high fiber and
fatty foods which are hard to digest. After diarrhea has stopped continue to
give the child one extra meal daily for about 2 weeks to avoid malnutrition.
Giving
‘Jeewani’ (oral rehydration solution) helps to replace the salt and water loss.
Investigations
are not usually needed. But sometimes a medical practitioner may request a
stool full report and a stool culture for management purposes.
Dissolve
the whole sachet in 1 liter (2 ½ elephant drink bottles) of clean water. This
can be used for 24 hours. Give whenever the child feels thirsty or after each
loose motion. If vomiting, get the child to sip the solution in small amounts.
For infants use a spoon. Older child can drink with a cup. Throw away the
remaining solution after 24 hours. If necessary a fresh solution should be
prepared. Never attempt to feed when the child is asleep or unconscious.
Do not give anti diarrhea’s or antibiotics unnecessarily.
Do not give anti diarrhea’s or antibiotics unnecessarily.
Wash
hands with soap and water especially before preparing food, eating and after
using the toilet
Drink
boiled and cooled water
Protect
cooked food from flies and cockroaches
Wash
raw fruits, vegetables and leaves before consumption
Use of
latrines and proper disposal of stools of young children
·
Measles vaccination can prevent diarrhea following measles
·
There is a new vaccine called Rotrix available in private
sector. This can prevent many diarrheas due to rota virus.