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Pediatric Emergency Medicine Practice Acute Gastroenteritis — An Update

July 2010

Abstract

Gastroenteritis refers to inflammation of the lining of both the stomach and small intestines. The majority of cases are infectious with viral organisms predominating; however, bacterial and parasitic infections can be a specific concern in the appropriate patient. Non-infectious gastrointestinal inflammation may follow certain ingestions (eg, toxic mushroom ingestion, gluten in patients with celiac disease, dairy in lactose sensitive patients), medications (eg, chemotherapeutic agents, non-steroidal anti-inflammatory medications, certain antibiotics), chemical toxins (eg, anticholinergic toxins, heavy metals, plant substances), and malignancy and can be seen in other conditions such as Crohn’s disease and ischemic bowel disease.

Although some acute gastroenteritis syndromes consist predominately of either vomiting or diarrhea, most have an element of both, with additional symptoms being variably present such as anorexia, abdominal pain, and fever. Clinicians should be wary of diagnosing children who present with isolated diarrhea or vomiting as having “viral gastroenteritis” until a thorough evaluation of other causes has been completed. A variety of serious conditions such as appendicitis, bacterial enteritis, diabetic ketoacidosis, pyelonephritis, pneumonia, intussusception, and toxic ingestions can present with symptoms identical to gastroenteritis. A thorough clinical examination, selective application of laboratory testing and diagnostic imaging, and documentation of suitable return precautions will prevent misdiagnoses and unexpected outcomes in these patients.

Keywords: gastroenteritis, dehydration, assessment, clinical signs, symptoms, treatment, rotovirus, norovirus, Crohn’s disease, ischemic bowel disease
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