Acute Gastroenteritis-Part 2
January 28th 2012 09:28
In this case we are pretty much sure that this is acute gastroenteritis, especially if it is clear in our history that the condition is food-related (though not all gastroenteritis are such). Fortunately no signs of dehydration were noted. At the back of our mind however, we should not forget surgical conditions like bowel obstruction, gall bladder disease, or appendicitis. Bowel obstruction initially can manifest with hyperactive bowel sounds. It can also manifest vomiting and overflow diarrhea. Any inflammation within the peritoneum can cause hypoactivity or hyperactivity of the gastrointestinal tract like gall bladder disease or appendicitis. These differential diagnoses however should not be considered unless close observation of the pattern and location of abdominal tenderness and other symptoms was done.
Knowing this, what are the possible problems we anticipate? Dehydration and electrolyte imbalance may ensue. Therefore adequate fluid intake has to be ensured. Baseline serum potassium and sodium has to be determined since in vomiting we expect potassium loss and in diarrhea sodium is expected to be lost. Hydration is started in anticipation that diarrhea and vomiting shall continue. Personally we would start on oral rehydration. However if she would not tolerate such management because of persistent symptoms, this will be the time that we shift to intravenous fluid administration. As for dietary management, diet as tolerated is indicated if vomiting ceases. If vomiting ensues, NPO is indicated temporarily. We can then gradually progress to soft diet, low salt, low fat.
Is fecalysis always needed? No. We would order fecalysis in the following conditions: bloody stool, recurrent diarrhea, or history of worms moving out from the bowel.
Is fecalysis always needed? No. We would order fecalysis in the following conditions: bloody stool, recurrent diarrhea, or history of worms moving out from the bowel.
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