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Inflammation of the stomach and intestines, resulting in vomiting, diarrhoea, and dehydration, most often caused by infection.
Inflammation of the stomach and intestines, resulting in vomiting, diarrhoea, and dehydration, most often caused by infection.
Risk Factors
Age under 5 years
Childcare or school attendance
Poor hand hygiene or sanitation
Overseas travel
Immunosuppression
Lack of rotavirus vaccination
Exposure to contaminated food or water
Aetiology
Viral causes include rotavirus norovirus adenovirus astrovirus
Bacterial causes include campylobacter salmonella shigella pathogenic E coli (e.g. EHEC) clostridioides difficile
Parasitic causes include giardia lamblia cryptosporidium entamoeba histolytica
Pathophysiology
Enteric pathogens damage the intestinal mucosa or disrupt absorption
This leads to secretory or osmotic diarrhoea vomiting and fluid loss
Inflammation may exacerbate intestinal permeability and motility
Diagnosis
Clinical diagnosis based on history of acute diarrhoea vomiting fever and signs of dehydration
Check hydration status including capillary refill time skin turgor mucous membranes urine output and alertness
Differential Diagnosis
Food intolerance or allergy
Inflammatory bowel disease
Appendicitis or mesenteric adenitis
UTI
Sepsis
Toxin ingestion
Intussusception (especially if bloody stools)
Investigations
Usually clinical diagnosis
Stool MCS and viral PCR if prolonged symptoms immunocompromised bloody stools or recent travel
UEC to assess dehydration and electrolyte derangement
Consider FBC CRP and blood cultures if febrile or unwell
Rapid antigen or PCR for rotavirus in infants
Management
Oral rehydration with WHO or electrolyte solution is first line
IV fluids if moderate to severe dehydration or unable to tolerate oral intake
Resume normal feeding as soon as tolerated
Anti-emetics (e.g. ondansetron) may reduce vomiting and aid oral rehydration in children
Avoid anti-diarrhoeals in children
Antibiotics only if bacterial cause confirmed or suspected with systemic features
Contact precautions and good hand hygiene to prevent spread
Complications & Prognosis
Dehydration and electrolyte disturbances
Hypoglycaemia
Metabolic acidosis
Seizures secondary to electrolyte imbalance
Prolonged illness in infants or immunocompromised
Generally self-limiting and good prognosis with appropriate hydration
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