Gastroenteritis in adults

Gastroenteritis in Adults
Gastroenteritis is an infection of the gut. It causes diarrhoea, and may also cause vomiting,abdominal pain and other symptoms. In most cases the infection clears over several days, butsometimes takes longer. The main risk is dehydration. The main treatment is to have lots to drinkwhich aims to avoid dehydration. You should also eat as normal y as possible. See a doctor if yoususpect that you are dehydrating, or if you have any worrying symptoms such as those which arelisted below.
What is gastroenteritis and what causes it? Gastroenteritis is an infection of the gut (intestines). The severity can range from a mild tummy upset for a day ortwo with some mild diarrhoea, to severe diarrhoea and vomiting for several days or longer. Many viruses, bacteriaand other microbes (germs) can cause gastroenteritis.
A virus is the most common cause of gastroenteritis. For example, infection with noroviruses and adenovirusesare common causes of gastroenteritis in adults in the UK, but other viruses can also be the cause. Viruses areeasily spread from one person to another by close contact. This is often because of the virus being present onpeople's hands after they have been to the toilet. Surfaces or objects touched by the infected person can alsoallow transmission of the virus. The virus can also be passed on if the infected person prepares food. Outbreaksof a virus causing gastroenteritis in many people can occur - for example, in schools, hospitals or nursinghomes. Food poisoning (eating food infected with microbes) causes some cases of gastroenteritis. Many different typesof microbes can cause food poisoning. Common examples are species of bacteria called Campylobacter,Salmonella and Escherichia coli (usually shortened to E. coli). Toxins (poisons) produced by bacteria can alsocause food poisoning. Another group of microbes called parasites can also be a cause. Water contaminated bybacteria or other microbes is another common cause, particularly in countries with poor sanitation. See separateleaflet called 'Food Poisoning in Adults' for further details.
This is a general leaflet about gastroenteritis. There are also other leaflets that give more details about some ofthe different microbes that cause gastroenteritis.
Gastroenteritis is common. About 1 in 5 people in the UK will develop a gastroenteritis in a year. Most people havea mild form of gastroenteritis and do not need to seek medical advice or to visit their doctor.
What are the symptoms of gastroenteritis? The main symptom is diarrhoea, often with vomiting as well. Diarrhoea means loose or watery stools(faeces), usually at least three times in 24 hours. Blood or mucus can appear in the stools with someinfections.
Crampy pains in your abdomen (tummy) are common. Pains may ease for a while each time youpass some diarrhoea.
A high temperature (fever), headache and aching limbs sometimes occur.
If vomiting occurs, it often lasts only a day or so, but sometimes longer. Diarrhoea often continues after thevomiting stops and commonly lasts for several days or more. Slightly loose stools may persist for a week or sofurther before a normal pattern returns. Sometimes the symptoms last longer.
Symptoms of dehydration
Diarrhoea and vomiting may cause dehydration (a lack of fluid in the body). Consult a doctor quickly if yoususpect you are becoming dehydrated. Mild dehydration is common and is usually easily reversed by drinking lotsof fluids. Severe dehydration can be fatal unless quickly treated because the organs of your body need a certainamount of fluid to function.
Symptoms of dehydration in adults include: tiredness, dizziness or light-headedness, headache,muscular cramps, sunken eyes, passing little urine, a dry mouth and tongue, weakness, andbecoming irritable.
Symptoms of severe dehydration in adults include: weakness, confusion, rapid heart rate, coma, andproducing very little urine. Severe dehydration is a medical emergency and immediate medicalattention is needed.
Dehydration in adults with gastroenteritis is more likely to occur in: Elderly or frail people.
Pregnant women.
People with severe diarrhoea and vomiting. In particular, if you are not able to replace the fluid lost withenough drinks.
How is gastroenteritis diagnosed and do I need any tests? Most people with gastroenteritis recognise this from their typical symptoms and they do not usually need to see adoctor or to seek medical advice. Symptoms are often quite mild and commonly get better within a few dayswithout any medical treatment.
However, in some circumstances, you may need to see a doctor when you have gastroenteritis (see below aboutwhen to seek medical advice). The doctor may ask you questions about recent travel abroad, if you have been incontact with someone with similar symptoms, or if you have recently taken antibiotics or been admitted tohospital. This is to look for possible causes of your gastroenteritis. The doctor will also usually check you forsigns of dehydration. They may check your temperature, pulse and blood pressure. They may also examine yourabdomen to look for any tenderness. Tests are not usually needed. However, if you are particularly unwell, have bloody stools, have recently travelledabroad, are admitted to hospital, or your symptoms are not getting better, then your doctor may ask you to collecta stool sample. This can then be examined in the laboratory to look for the cause of the infection.
Seek medical advice in any of the following situations, or if any other symptoms occur that you are concernedabout: If you suspect that you are becoming dehydrated.
If you are vomiting a lot and unable to keep fluids down.
If you have blood in your diarrhoea or vomit.
If you have severe abdominal pain.
If you have severe symptoms, or if you feel that your condition is getting worse.
If you have a persisting high fever.
If your symptoms are not settling - for example, vomiting for more than 1-2 days, or diarrhoea thatdoes not start to settle after 3-4 days.
Infections caught abroad.
If you are elderly or have an underlying health problem such as diabetes, epilepsy, inflammatory boweldisease, kidney disease.
If you have a weakened immune system because of, for example, chemotherapy treatment, long-termsteroid treatment, HIV infection.
If you are pregnant.
What is the treatment for gastroenteritis in adults? Symptoms often settle within a few days or so as your immune system usually clears the infection. Occasionally,admission to hospital is needed if symptoms are severe, or if complications develop (see below). The following are commonly advised until symptoms ease.
Fluids - have lots to drink
The aim is to prevent dehydration, or to treat dehydration if it has developed. (Note: if you suspect that you are
dehydrated, you should contact a doctor.)
As a rough guide, drink at least 200 mls after each bout of diarrhoea (after each watery stool).
This extra fluid is in addition to what you would normally drink. For example, an adult will normally drinkabout two litres a day, but more in hot countries. The above advice of 200 mls after each bout ofdiarrhoea is in addition to this usual amount that you would drink.
If you vomit, wait 5-10 minutes and then start drinking again, but more slowly. For example, a sip every2-3 minutes, but making sure that your total intake is as described above.
You will need to drink even more if you are dehydrated. A doctor will advise on how much to drink if youare dehydrated.
For most adults, fluids drunk to keep hydrated should mainly be water, Also, ideally, include some soup. It is bestnot to have drinks that contain a lot of sugar, such as cola or pop, as they can sometimes make diarrhoea worse.
Rehydration drinks are recommended for people who are frail, or over the age of 60, or who have underlyinghealth problems. They are made from sachets that you can buy from pharmacies. (The sachets are alsoavailable on prescription.) You add the contents of the sachet to water. Rehydration drinks provide a good balanceof water, salts, and sugar. The small amount of sugar and salt helps the water to be absorbed better from the gutinto the body. They do not stop or reduce diarrhoea. Do not use home-made salt/sugar drinks, as the quantity ofsalt and sugar has to be exact.
Anti-secretory medicines are designed to be used with rehydration treatment. They reduce the amount of waterthat is released into the gut during an episode of diarrhoea. Eat as normally as possible
It used to be advised to not eat for a while if you had gastroenteritis. However, now it is advised to eat small, light
meals if you can. Be guided by your appetite. You may not feel like food and most adults can do without food for a
few days. Eat as soon as you are able - but don't stop drinking. If you do feel like eating, avoid fatty, spicy or heavy
food at first. Plain foods such as wholemeal bread and rice are good foods to try eating first.
Medication
Antidiarrhoeal medicines are not usually necessary. However, you may wish to reduce the number of trips that
you need to make to the toilet. You can buy antidiarrhoeal medicines from pharmacies. The safest and most
effective is loperamide. The adult dose of this is two capsules at first. This is followed by one capsule after each
time you pass some diarrhoea up to a maximum of eight capsules in 24 hours. It works by slowing down your
gut's activity. You should not take loperamide for longer than five days.
Note: do not give antidiarrhoeal medicines to children under 12 years. Also, do not use antidiarrhoeal medicines if
you pass blood or mucus with the diarrhoea or if you have a high temperature. People with certain conditions
should not take loperamide. Therefore, read the leaflet that comes with the medicine to be safe. For example,
pregnant women should not take loperamide.
Paracetamol or ibuprofen is useful to ease a high temperature or headache.
As explained above, if symptoms are severe, or persist more than several days, your doctor may ask for asample of the diarrhoea. This is sent to the laboratory to look for infecting microbes (bacteria, parasites, etc).
Sometimes an antibiotic or other treatments are needed if certain bacteria or other infections are found to be thecause. Antibiotics are not needed for gastroenteritis caused by viruses, and may even make things worse.
Are there any complications that can occur from gastroenteritis? Complications are uncommon in the UK. They are more likely in the very young, pregnant women, or the elderly.
They are also more likely if you have a chronic (ongoing) condition such as diabetes or if your immune systemmay not be working fully. For example, if you are taking long-term steroid medication or you are havingchemotherapy treatment for cancer. Possible complications include the following: Dehydration and salt (electrolyte) imbalance in your body. This is the most common
complication. It occurs if the water and salts that are lost in your stools, or when you vomit, are not
replaced by your drinking adequate fluids. If you can manage to drink plenty of fluids then dehydration
is unlikely to occur, or is only likely to be mild, and will soon recover as you drink. Severe dehydration
can lead to a drop in your blood pressure. This can cause reduced blood flow to your vital organs. If
dehydration is not treated, kidney failure may also develop. Some people who become severely
dehydrated need a drip of fluid directly into a vein. This requires admission to hospital.
Reactive complications. Rarely, other parts of the body may react to an infection that occurs in the
gut. This can cause symptoms such as arthritis (joint inflammation), skin inflammation and eye
inflammation (either conjunctivitis or uveitis). Reactive complications are uncommon when a virus
causes gastroenteritis.
Spread of infection to other parts of your body such as your bones, joints, or the meninges that
surround your brain and spinal cord. This is rare. If it does occur, it is more likely if gastroenteritis is
caused by Salmonella spp. infection.
Persistent diarrhoea syndromes may rarely develop.
Irritable bowel syndrome is sometimes triggered by a bout of gastroenteritis.
Lactose intolerance can sometimes occur for a while after gastroenteritis. This is known as
secondary or acquired lactose intolerance. Your gut lining can be damaged by the episode of
gastroenteritis. This leads to lack of an enzyme (chemical) called lactase that is needed to help your
body digest a sugar called lactose that is in milk. Lactose intolerance leads to bloating, abdominal
pain, wind and watery stools after drinking milk. The condition gets better when the infection is over
and the gut lining heals. It is more common in children.
Haemolytic uraemic syndrome is another potential complication. It is rare and is usually associated
with gastroenteritis caused by a certain type of E. coli infection. It is a serious condition where there is
anaemia, a low platelet count in the blood, and kidney failure. It is more common in children. If
recognised and treated, most people recover well.
Reduced effectiveness of some medicines. During an episode of gastroenteritis, certain
medicines that you may be taking for other conditions or reasons may not be as effective. This is
because the diarrhoea and/or vomiting means that reduced amounts of the medicines are absorbed
(taken up) into your body. Examples of such medicines are medicines for epilepsy, diabetes and
contraception. Speak to your doctor or practice nurse if you are unsure of what to do if you are taking
other medicines and have gastroenteritis.
Gastroenteritis can be easily passed on from person to person. If you have gastroenteritis, the following arerecommended to prevent the spread of infection to others: Wash your hands thoroughly after going to the toilet. Ideally, use liquid soap in warm running water, butany soap is better than none. Dry properly after washing.
Don't share towels and flannels.
Don't prepare or serve food for others.
Regularly clean the toilets that you use, with disinfectant. Wipe the flush handle, toilet seat, bathroomtaps, surfaces and door handles with hot water and detergent at least once a day. Keep a cloth just forcleaning the toilet (or use a disposable one each time).
Stay off work, college, etc, until until at least 48 hours after the last episode of diarrhoea or vomiting.
Food handlers: if you work with food and develop diarrhoea or vomiting, you must immediately leavethe food-handling area. For most, no other measures are needed, other than staying away from workuntil at least 48 hours after the last episode of diarrhoea or vomiting. Some special situations mayarise and sometimes longer time off is needed. Specialist advice may be needed for some uncommoncauses of gastroenteritis. If in doubt, seek advice from your employer or GP.
If the cause of gastroenteritis is known to be (or suspected to be) a microbe called Cryptosporidiumspp., you should not swim in swimming pools for two weeks after the last episode of diarrhoea.
The advice given in the previous section is mainly aimed at preventing the spread of infection to other people.
However, even when we are not in contact with someone with gastroenteritis, proper storage, preparation andcooking of food, and good hygiene help to prevent gastroenteritis. After you go to the toilet.
Before you touch food.
Between handling raw meat and food ready to be eaten. (There may be some bacteria on raw meat.)After gardening.
After playing with pets (healthy animals can carry certain harmful bacteria).
The simple measure of washing hands regularly and properly is known to make a big difference to the chance ofdeveloping gastroenteritis.
You should also take extra measures when in countries of poor sanitation. For example, avoid water and otherdrinks that may not be safe, and avoid food washed in unsafe water.
NICE CKS, September 2009 Hand washing for preventing diarrhoea. Cochrane Database Syst Rev. 2008 Jan23;(1):CD004265.
Evidence summary new medicine NICE (Mar 2013) Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical
conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its
accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
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