विवरण
Acute viral gastroenteritis is a common condition in children, typically caused by viruses such as rotavirus, norovirus, or adenovirus, leading to inflammation of the gastrointestinal tract.
Clinical features include sudden onset of vomiting, diarrhea, abdominal pain, fever, and sometimes dehydration, which can be severe, especially in younger children. Children with viral gastroenteritis may exhibit symptoms of lethargy, decreased urine output, dry mucous membranes, and poor feeding due to nausea and abdominal discomfort. Diagnosis is primarily based on clinical presentation, with stool studies occasionally performed to identify the specific virus responsible. Physical examination may reveal signs of dehydration, such as sunken eyes, decreased skin turgor, and rapid heart rate, requiring prompt fluid rehydration.
Treatment focuses on supportive care, including oral or intravenous rehydration to prevent and manage dehydration, and adequate nutrition to support recovery. Antiemetics may be considered for persistent vomiting, while antibiotics are generally not indicated unless bacterial coinfection is suspected.
सारांश
- Gastroenteritis, or inflammation of the intestines, can be infectious or inflammatory. Infectious types can be bacterial, while inflammatory types include IBD. Parasitic infections can also cause gastroenteritis.
- Gastroenteritis is defined clinically by a decrease in stool consistency and/or an increase in stool frequency (more than three times in 24 hours), potentially with fever or vomiting. In neonates, a change in stool consistency compared to previous stools is a key indicator. Diarrhea is a symptom, not a diagnosis, and its causes can range from inflammation to drug-induced to food poisoning.
- Viral gastroenteritis accounts for approximately 70% of all gastroenteritis cases. It is a leading cause of death worldwide in children under five years old. Rotavirus is the most common viral cause in this age group.
- Acute gastroenteritis can be caused by viral, bacterial, protozoal, parasitic, or fungal infections. Surgical causes and systemic infections can also be factors. Viruses are the most common cause overall, with rotavirus being the most frequent culprit.
- The small intestine contains epithelial cells with villi and crypts, which are crucial for absorption and secretion. Villi contain sodium-hydrogen antiports and sodium-dependent solute transporters for nutrient absorption. Crypt cells secrete chloride and water to make the food bolus isoosmotic.
- Viruses like rotavirus and adenovirus bind to villi and crypts. This binding can lead to toxin release, epithelial cell death, inflammation, and activation of endocrine cells. The result is decreased or increased motility and diarrhea.
- Diagnosis of acute gastroenteritis involves considering diarrhea, vomiting, nausea, and fever. It's important to differentiate viral gastroenteritis from bacterial causes, colitis, and food protein allergies. Key factors include the acute onset, high stool frequency, large volume, and duration of less than one week.
- Dehydration assessment is critical in children with acute gastroenteritis. Dehydration is classified as mild, moderate, or severe based on general condition, eye appearance, thirst, and skin pinch. The degree of dehydration guides treatment decisions, including the need for admission.
- Management focuses on correcting dehydration, ongoing fluid replacement, zinc supplementation, and potentially probiotics. Oral rehydration solutions (ORS) are crucial for rehydration and electrolyte balance. Zinc supplements reduce the duration of diarrhea and prevent recurrence, with specific dosages for children under and over six months.
- Probiotics, particularly Lactobacillus rhamnosus GG and Saccharomyces boulardii, can reduce the duration of diarrhea. Racecadotril, a secretory agent, may be used in severe watery diarrhea. Antibiotics and antimotility agents are generally not recommended.
- Prevention involves sanitation, hygienic drinking water, and rotavirus vaccination. Rotavirus vaccines have significantly reduced rotavirus gastroenteritis and associated hospitalizations and mortality.
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