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Viral gastroenteritis

Medicine > Infection

Background knowledge 🧠

Definition

  • Acute inflammation of the gastrointestinal tract caused by viral infection.
  • Characterised by diarrhoea, vomiting, and abdominal pain.
  • Self-limiting, usually resolves within 1 to 3 days.
  • Commonly referred to as “stomach flu”.

Epidemiology

  • Common worldwide, particularly in children under 5 years.
  • Leading cause of acute diarrhoea globally.
  • Incidence peaks in winter months, especially in temperate climates.
  • Norovirus is the most common cause in adults, rotavirus in children.
  • Responsible for significant morbidity and mortality in developing countries.

Aetiology and Pathophysiology

  • Common causative viruses: Norovirus, Rotavirus, Adenovirus, Astrovirus.
  • Transmission is typically faecal-oral via contaminated food, water, or surfaces.
  • Viral replication occurs in the small intestine, leading to malabsorption and diarrhoea.
  • Infected enterocytes are shed, causing an inflammatory response.
  • Dehydration is a major risk due to fluid loss from diarrhoea and vomiting.

Types

  • Norovirus: Leading cause in adults, associated with outbreaks in closed environments.
  • Rotavirus: Most common in children under 5, severe in neonates.
  • Adenovirus: Often affects infants and young children, causes prolonged diarrhoea.
  • Astrovirus: Mild symptoms, typically affects young children and the elderly.

Clinical Features 🌡️

Symptoms

  • Acute onset of diarrhoea (non-bloody).
  • Nausea and vomiting.
  • Abdominal cramps and pain.
  • Fever and malaise.
  • Myalgia and headache in some cases.

Signs

  • Signs of dehydration: dry mucous membranes, decreased skin turgor, tachycardia.
  • Fever (low-grade).
  • Abdominal tenderness on palpation.
  • Reduced urine output.
  • In severe cases: hypotension, altered mental status.

Investigations 🧪

Tests

  • Diagnosis is primarily clinical.
  • Stool sample analysis if symptoms are severe, prolonged, or in vulnerable populations.
  • Stool PCR or ELISA for viral pathogens.
  • Blood tests to assess electrolytes and renal function in severe cases.
  • Consider abdominal imaging if alternate diagnosis is suspected.

Management 🥼

Management

  • Rehydration is the mainstay of treatment: Oral Rehydration Solutions (ORS).
  • Intravenous fluids in severe dehydration or inability to tolerate oral intake.
  • Antiemetics may be used to control vomiting.
  • Antidiarrheal medications are generally not recommended.
  • Nutritional support with early reintroduction of food.
  • Antiviral medications are not typically indicated.

Complications

  • Dehydration: Can be life-threatening, especially in children and the elderly.
  • Electrolyte imbalances: Hyponatraemia, hypokalaemia.
  • Secondary bacterial infections.
  • Prolonged diarrhoea: More common in immunocompromised patients.
  • Post-infectious irritable bowel syndrome (IBS).

Prognosis

  • Generally good with supportive care.
  • Most patients recover within 1-3 days.
  • Severe outcomes are rare in healthy individuals.
  • Higher risk of severe disease in the very young, elderly, and immunocompromised.
  • Vaccination (e.g., rotavirus vaccine) can prevent severe disease in children.

Key Points

  • Viral gastroenteritis is a common, self-limiting condition.
  • Hydration is critical to prevent complications.
  • Good hygiene practices are essential to prevent transmission.
  • Rotavirus vaccination has reduced incidence in children.

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Infection