0071643192.pdf

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

TABLE 11.6. Common Causes of Noninvasive Gastroenteritis

CAUSATIVEAGENT INCUBATION ANDTRANSMISSION DESCRIPTION THERAPY

Viral gastroenteritis 11–72 hr; person-to-person, Norwalk and Rotavirus most Self-limiting; supportive care

fecal-oral, contaminated food common agents; nausea, with PO or IV hydration and

or water vomiting, and watery diarrhea; antiemetics

usually afebrile; may have

mild abdominal cramps

and myalgias

G. lamblia 1–4 wk; contaminated food or Backpackers, campers, the Metronidazole

water, person-to-person, elderly; also homosexual males,

fecal-oral persons in institutions; most

common intestinal parasite

in the U.S.; abdominal cramping,

bloating, flatus, malabsorptive

chronic diarrhea

Staphylococcus 1–6 hr; previously cooked Nausea, severe vomiting, Supportive care with IV

aureus food (ham, egg salad, potato diarrhea, mild abdominal fluids and symptomatic

salad) cramps; symptoms caused by treatment;

preformed entertoxins antibiotics ineffective

Bacillus cereus 1–6 hr; previously cooked Abrupt onset of nausea, Supportive care with IV

meats, fried rice, vegetables vomiting, and mild diarrhea; fluids and symptomatic

and dried fruits caused by preformed treatment;

enterotoxins antibiotics ineffective

Clostridium 8–24 hr; previously cooked Abdominal cramps, nausea, Supportive care with IV

perfringens or reheated meats and poultry minimal vomiting, and watery fluids and symptomatic

diarrhea; caused by enterotoxins treatment

Vibrio cholerae 11–72 hr; raw or Explosive rice-water diarrhea; Fluid resuscitation is critical;

undercooked seafood, vomiting, fever, abdominal ciprofloxacin, bactrim, or

fecal-oral, contaminated cramps, dehydration, lactic tetracycline may shorten the

water acidosis; enterotoxins are course of disease

formed before and after

bacterial colonization

Enterotoxigenic 11–72 hr; contaminated Traveler’s diarrhea; profuse Self-limiting; supportive care; if

Escherichia coli water watery diarrhea; caused by severe, ciprofloxacin

enterotoxins

Antibiotic-associated Temporally associated with Mild severity without cramps, Withdrawal of

enteritis antibiotic use fever, or fecal leukocytes antibiotic