Acute Gastroenteritis in Sickle Cell Disease

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Questions and Answers

Which organism is the most frequent cause of gastroenteritis in patients with sickle cell disease?

Salmonella species (correct)

Norovirus

Campylobacter jejuni

Escherichia coli

What is a common symptom indicative of dehydration in an individual with acute gastroenteritis?

Increased appetite

Flushed skin

Weight gain

Irritability (correct)

Which type of stools are more consistent with bacterial gastroenteritis?

Soft and formed

Stools with blood or mucous (correct)

Mucous and yellow

Watery and clear

What is a clinical finding indicative of severe dehydration?

Deeply sunken eyes Signup and view all the answers

When lab studies are not required in cases of gastroenteritis?

When the etiology is clear and some dehydration exists Signup and view all the answers

Which is a symptom of mild to moderate dehydration?

Thirsty Signup and view all the answers

What symptom is not associated with acute gastroenteritis?

Excessive urination Signup and view all the answers

What is the initial recommended intervention for managing dehydration in children?

Oral rehydration solution (ORS) Signup and view all the answers

What is a potential complication of acute gastroenteritis?

Hemolytic uremic syndrome Signup and view all the answers

How can skin turgor be assessed effectively?

By pinching the skin on the abdomen or thigh Signup and view all the answers

In cases of minimal or no dehydration, what should be done for breastfed infants?

Increase breastfeeding frequency Signup and view all the answers

Which of the following factors may require a complete workup including blood cultures?

Presence of pus or RBCs in stool Signup and view all the answers

What can cause seizures in a patient with diarrhea?

Electrolyte imbalance Signup and view all the answers

What is not considered a symptom of severe dehydration?

Alert mental state Signup and view all the answers

How should ORS be administered for ongoing fluid losses in children with diarrhea?

10 mL/kg for each loose stool Signup and view all the answers

Which of the following is true about the management for acute gastroenteritis?

An age-appropriate unrestricted diet is recommended after rehydration Signup and view all the answers

What is the osmolarity of WHO-ORS from 2002?

245 mOsm/L Signup and view all the answers

What constitutes a fever in adults?

Temperature above 100.4°F (38°C) Signup and view all the answers

Which characteristic describes the rash associated with chickenpox?

Small red papules that rapidly progress to oval vesicles on a white base Signup and view all the answers

What is the recommended oral rehydration solution volume for mild-to-moderate dehydration?

50-100 mL/kg over 2-4 hours Signup and view all the answers

Which of the following describes a maculopapular rash?

Combination of flat and raised lesions that blanch on pressure Signup and view all the answers

Which statement accurately describes the characteristics of a vesicle?

An elevated skin lesion less than 1 cm in diameter filled with fluid Signup and view all the answers

In the case of hypernatremic dehydration, what is the duration for correcting the condition using ORS?

12 hours Signup and view all the answers

What is a distinguishing feature of rubella compared to measles?

Patient looks less ill Signup and view all the answers

What factor is NOT essential to consider during patient history when diagnosing a fever with a rash?

The patient's favorite color Signup and view all the answers

What is the osmolarity of Apple Juice?

730 mOsm/L Signup and view all the answers

Which of the following conditions is characterized by tender red nodules due to exudation of blood and serum?

Erythema Nodosum Signup and view all the answers

Which of the following is NOT a reason to admit children with acute gastroenteritis (AGE)?

Mild dehydration Signup and view all the answers

Which diagnostic method is current for identifying chickenpox?

PCR testing Signup and view all the answers

In the context of rash morphology, what does 'monomorphic' refer to?

Rashes consisting of similar types of lesions Signup and view all the answers

Which pathogen is most likely associated with a maculopapular rash?

HIV Signup and view all the answers

What symptom is prominent in scarlet fever?

Streptococcal throat infection Signup and view all the answers

What should be given to severely dehydrated children initially?

IV bolus of 20-30 mL/kg Signup and view all the answers

What is the osmolarity range of Gatorade?

290-303 mOsm/L Signup and view all the answers

In which condition do Koplik spots appear?

Measles Signup and view all the answers

What pattern describes lesions that arise following local skin trauma?

Koebner phenomenon Signup and view all the answers

Which of the following is a characteristic of an urticarial rash?

Rapidly appearing and resolving swelling of the lesions Signup and view all the answers

Which of the following viruses can be associated with petechial-purpuric rashes?

HIV Signup and view all the answers

What volume of ORS is recommended for rehydration after initial IV treatment in children?

70 mL/kg over 5 hours Signup and view all the answers

What type of rash is typically associated with measles?

Blanching erythematous maculopapular rash Signup and view all the answers

Which of the following antimicrobials is recommended for treating C difficile infections?

Metronidazole Signup and view all the answers

What is a significant risk associated with the use of loperamide as an antidiarrheal?

Severe abdominal distention Signup and view all the answers

Which probiotic strain has been found effective in reducing the duration of diarrhea?

Lactobacillus GG Signup and view all the answers

According to WHO recommendations, what is the dosage of zinc supplementation for children under 5 years with acute gastroenteritis?

10-20 mg/day for 10-14 days Signup and view all the answers

Which of these is NOT a recommended preventive measure for diarrhea?

Using antifungal medications Signup and view all the answers

Study Notes

Fever

Fever is a temperature above 100.4°F (38°C).
It's a normal response to various conditions, with infection being the most common.

Rash

A rash is a skin change affecting color, appearance, or texture.
It can be localized to one body part or affect the entire skin.

Rash Presentation

Features of the rash: Characteristic features of the lesions, distribution, progression, timing of onset (relative to fever), and morphological changes (e.g., papules to vesicles).

Common Skin Lesions

Macule: Non-palpable, circumscribed, flat lesion (<1 cm in diameter).
Papule: Palpable, elevated lesion (<1 cm in diameter).
Maculopapular: Combination of macular and papular lesions.
Purpura: Non-blanching papules or macules.
Vesicle: Fluid-filled, elevated skin lesion (<1 cm in diameter).
Bulla: Fluid-filled, elevated skin lesion (>1 cm in diameter).
Pustule: Pus-containing vesicle.

Other Skin Lesions

Cyst
Fissure
Macule
Nodule
Papule
Polyp
Pustule
Vesicle
Wheal

History

Important considerations include the patient's age, current season, travel history, geographic location, exposure to ill individuals or animals/insects, medications, and immunization history.

Physical Examination

Distribution pattern: symmetrical versus asymmetrical rashes.
Morphology: monomorphic versus pleomorphic.
Configuration: linear, annular, grouped, and Koebner phenomenon (eruption in an area of local trauma).

Differential Diagnosis of Fever with Rash

Maculopapular rash: Pathogens can include viral, bacterial, or other conditions.
Diffuse erythroderma: Bacterial (scarlet fever, Toxic Shock Syndrome, Staph SSS), fungal (Candida albicans), other (Kawasaki syndrome).
Urticarial rash: Viral (EBV, Hep B, HIV), bacterial (M. pneumoniae, Group A strep), other (drug reaction).
Vesicular, pustular, bullous: Viral (HSV, VZV, Coxsackievirus), bacterial (Staph SSS, Staph bullous impetigo, Impetigo, strep-crusted impetigo), other (Toxic epidermal necrolysis, Steven-Johnson Syndrome, Rickettsial pox).
Petechial-purpuric: Viral (atypical measles, congenital rubella, CMV, enterovirus, HIV, HF), bacterial (Sepsis, meningococcal, gonococcal, pneumococcal, Hib), or IE.
Erythema Nodosum: Viral (EBV, HBV), bacterial (Group A Streptococcus, TB, yersinia), fungal (Coccidiomycosis, histoplasmosis), or other (Sarcoidosis).

Infectious Causes

Measles: Blanching erythematous maculopapular rash, symptoms include fever, cough, coryza, conjunctivitis, Koplik spots. Diagnosis: measles IgM, detectable for 1 month after illness.
Chickenpox: Small red papules progress to oval, non-umbilicated, teardrop vesicles on erythematous base, new crops for 3-4 days, starting on the trunk, followed by the head, face, and sometimes extremities. Diagnosis: PCR is current diagnostic method.
Rubella: Rash resembles measles but patient is not ill looking, prominent postauricular, posterior cervical, and suboccipital adenopathy, Forschheimer spots on soft palate (in 20% of patients). Diagnosis: IgM antibodies diagnostic for congenital rubella syndrome.
Scarlet fever: Exotoxin-mediated diffuse erythematous rash, pharyngitis due to group A Streptococcus, coarse, sandpaper-like rash, desquamation, circumoral pallor, and strawberry tongue. Diagnosis: Streptococcus present in throat swab.
Dengue Fever: Tropical, mosquito-borne disease, symptoms include high fever, skin rash, eye and joint aches, backaches, headaches, loss of appetite, nausea, vomiting, and bleeding (nose, gums).
Typhoid fever: Bacterial infection from Salmonella, common in unsanitary areas, persistent fever, rash with pink blanching spots on stomach or chest, headache, sore throat, tiredness, stomach pain, constipation, and diarrhea.
Typhus: Rickettsial bacterial infection transmitted by arthropods, severe headache, high fever, rash, confusion, stupor, hypotension, sensitivity to bright lights, and severe muscle pain.

Inflammatory Causes – Kawasaki Vasculitis

Usually in kids <4 years old.
Symptoms include fever >5 days, bilateral conjunctival injection, injected, or fissured lips, injected pharynx or strawberry tongue, erythema of palms or soles, edema of hands or feet, generalized or periungual desquamation, rash, and cervical lymphadenopathy.

Systemic Lupus Erythematosus

Autoimmune disease where the body's immune system attacks healthy tissues in many body parts.
Symptoms include: pleuritis or pericarditis, discoid rash, malar rash, photosensitive rash, oral ulcers, arthritis, anemia, leukopenia, lymphopenia, thrombocytopenia, and renal nephritis.

Infectious Mononucleosis

Caused by Epstein-Barr virus (EBV).
Symptoms include fever, malaise, Tonsillopharyngitis, lymphadenopathy, petechiae on soft palate, and splenomegaly/hepatomegaly/maculopapular rash.

Dehydration

Symptoms include abnormally sleepy, lethargic behavior, sunken eyes, irritability, no tears when crying, thirst, dry mouth and skin.
Severe dehydration requires admission to a hospital for intravenous fluids.
Mild to moderate dehydration can be managed with oral rehydration solutions (ORS).
Evaluating skin turgor to determine degrees of dehydration.
ORS should be given for hypernatremia cases within 12 hours and not 4.

Acute Gastroenteritis (AGE)

Inflammation of the Gastrointestinal tract.
Symptoms include diarrhea, fever, and vomiting.

Diarrhea

Watery stools are more consistent with viral gastroenteritis.
Stools with blood or mucous indicate a bacterial pathogen.
A long duration of diarrhea (>14 days) might suggest a parasitic or non-infectious cause.

Diagnostic Considerations

Lab studies (serum electrolytes, bicarbonate, glucose, blood urea and creatinine, urine specific gravity, and stool examination) are helpful with severe dehydration, not otherwise.
Stool examination for pus, RBC or gross blood helps determine potential bacterial causes. Viral detection in stool is also considered, as is evidence of systemic infection (CBC, blood cultures, urine cultures, chest radiography, and/or LP).

Complications

Dehydration
Electrolyte Imbalance (including sodium)
Seizures
Secondary carbohydrate malabsorption
Hemolytic uremic syndrome

Prevention

Vaccination (RotaTeq & Rotarix)
Probiotics
Hand washing
Clean food preparation and preservation

Anti-microbials

Generally not recommended.
Exceptions apply to C. difficile, Cholera, Giardia, and Cryptosporidium.

Anti-diarrheals

Generally not recommended.
Ondasetron is an exception and can be useful for children >6 months.

Probiotics

Live microbial feeding supplements.
Mechanisms include antimicrobial substance synthesis, nutrient competition, toxin modification, and nonspecific immune stimulation.
Showed to be effective in reducing diarrhea duration, especially Lactobacillus GG, and preventing C. difficile-associated diarrhea in patients on antibiotics.

Zinc

Zinc supplementation may reduce diarrhea duration in children older than 6 months in areas with zinc deficiency prevalent.
WHO recommends zinc supplementation for children <5 years old with acute gastroenteritis.

Differential Diagnoses (Gastroenteritis)

Infections outside the Gastrointestinal tract (eg, AOM, URI)
Chronic nonspecific diarrhea of childhood (toddler diarrhea)
Malabsorption syndromes
Inflammatory Bowel Disease
Pediatric Lactose Intolerance

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Description

Test your knowledge on acute gastroenteritis and its effects on patients with sickle cell disease. This quiz covers symptoms, dehydration management, and potential complications associated with gastroenteritis. Boost your understanding of clinical findings and appropriate interventions.