gastroenteritis

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Definition

Gastroenteritis is a catchall term for infection or irritation of the digestive tract, particularly the stomach and intestine. It is frequently referred to as the stomach or intestinal flu, although the influenza virus is not associated with this illness. Major symptoms include nausea and vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also accompanied by fever and overall weakness. Gastroenteritis typically lasts about three days. Adults usually recover without problem, but children, the elderly, and anyone with an underlying disease are more vulnerable to complications such as dehydration.

Description

Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarely life-threatening in the United States and other developed nations. However, an estimated 220,000 children younger than age five are hospitalized with gastroenteritis symptoms in the United States annually. Of these children, 300 die as a result of severe diarrhea and dehydration. In developing nations, diarrheal illnesses are a major source of mortality. In 1990, approximately three million deaths occurred worldwide as a result of diarrheal illness.

The most common cause of gastroenteritis is viral infection. Viruses such as rotavirus, adenovirus, astrovirus, and calicivirus and small round-structured viruses (SRSVs) are found all over the world. Exposure typically occurs through the fecal-oral route, such as by consuming foods contaminated by fecal material related to poor sanitation. However, the infective dose can be very low (approximately 100 virus particles), so other routes of transmission are quite probable.

Typically, children are more vulnerable to rotaviruses, the most significant cause of acute watery diarrhea. Annually, worldwide, rotaviruses are estimated to cause 800,000 deaths in children below age five. For this reason, much research has gone into developing a vaccine to protect children from this virus. Adults can be infected with rotaviruses, but these infections typically have minimal or no symptoms.

Children are also susceptible to adenoviruses and astroviruses, which are minor causes of childhood gastroenteritis. Adults experience illness from astroviruses as well, but the major causes of adult viral gastroenteritis are the caliciviruses and SRSVs. These viruses also cause illness in children. The SRSVs are a type of calicivirus and include the Norwalk, Southhampton, and Lonsdale viruses. These viruses are the most likely to produce vomiting as a major symptom.

Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking water, or contaminated food—conditions common in developing nations. Natural or man-made disasters can make underlying problems in sanitation and food safety worse. In developed nations, the modern food production system potentially exposes millions of people to disease-causing bacteria through its intensive production and distribution methods. Common types of bacterial gastroenteritis can be linked to Salmonella and Campylobacter bacteria; however, Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in developed nations. Cholera and Shigella remain two diseases of great concern in developing countries, and research to develop long-term vaccines against them is underway.

— Julia Barrett

Inflammation of the mucous membrane of the stomach and intestines.

Inflammation of the stomach and intestines. It is usually caused by a bacterial or viral infection associated with food poisoning. Symptoms include nausea, vomiting, and diarrhoea. Gastroenteritis may cause dehydration, which precludes vigorous physical activity. Victims of gastroenteritis should drink plenty of fluids and maintain a good salt balance. Infants are at particular risk of dehydration and may require intravenous fluid replacement.

An inflammation of the stomach and intestines accompanying numerous gastrointestinal (GI) disorders. Symptoms are anorexia, nausea, vomiting, abdominal discomfort, and diarrhea.

Definition

Gastroenteritis is a general term for infection or irritation of the digestive tract, particularly the stomach and intestine. It is frequently referred to as stomach or intestinal flu, although the influenza virus does not cause this illness. Major symptoms include nausea, vomiting, diarrhea, and abdominal cramps. Fever and overall weakness sometimes accompany these symptoms. Gastroenteritis typically lasts about three days. Adults usually recover without problem, but children, the elderly, and persons with an underlying disease are more vulnerable to complications such as dehydration.

Description

Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarely life-threatening in the United States and other developed nations. However, in the United States an estimated 220,000 children younger than age five are hospitalized annually with gastroenteritis symptoms. Of these children, 300 die as a result of severe diarrhea and dehydration. In developing nations, diarrhea-related illnesses are a major source of mortality. In 1990, approximately three million deaths occurred worldwide as a result of diarrheal illness.

Viral Gastroenteritis

Gastroenteritis is usually caused by infection with one of these viruses: rotavirus, adenovirus, astrovirus, calicivirus, and small round-structured viruses (SRSVs). These viruses are found all over the world and are particularly problematic where sanitation is poor. Typical exposure to these viruses occurs through the fecal-to-oral route, by ingesting food that is contaminated with fecal material or by coming in contact with an infected person's vomit or diarrhea and then inadvertently bringing the contaminant to the mouth. Other routes of transmission are quite likely, because exposure to as few as 100 virus particles can cause an infection.

Typically, children are more vulnerable to rotaviruses—the most common cause of acute watery diarrhea. It is estimated that each year rotaviruses cause 800,000 deaths worldwide in children younger than age five. For this reason, much research has gone into developing a vaccine to protect children from this virus. Adults can be infected with rotaviruses, but these infections typically have minimal or no symptoms.

Adenoviruses and astroviruses are minor causes of childhood gastroenteritis, and children may become infected with caliciviruses and SRSVs. Adults experience illness from astroviruses as well, but the major causes of adult viral gastroenteritis are the caliciviruses and SRSVs. The SRSVs are a type of calicivirus and include the Norwalk, Southhampton, and Lonsdale viruses. SRSVs are the most likely to produce vomiting as a major symptom.

Bacterial Gastroenteritis

Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking water, or contaminated food—conditions that are common in developing nations. Natural or man-made disasters can worsen underlying sanitation and food-safety problems. In developed nations, modern food production, handling, and distribution systems and methods may expose millions of people to disease-causing bacteria. Common types of bacterial gastroenteritis can be linked to Salmonella and Campylobacter bacteria; however, Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in developed nations. Cholera and shigella remain two diseases of great concern in developing countries, and research to develop long-term vaccines against them is underway.

Causes & Symptoms

Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites. Spoiled food may also cause illness. Certain medications and excessive alcohol can irritate the digestive tract to the point of inducing gastroenteritis. Regardless of the cause, the symptoms of gastroenteritis include diarrhea, nausea, vomiting, abdominal pain, and cramps. Sufferers may also experience bloating, low fever, and overall tiredness. Typically, the symptoms last only two to three days, but some viruses may last up to a week.

A typical bout of gastroenteritis should not require a visit to the doctor. However, medical treatment is essential if symptoms worsen or if there are complications. Infants, young children, the elderly, and persons with underlying disease require special attention in this regard.

Dehydration is the greatest danger presented by gastroenteritis. The loss of fluids through diarrhea and vomiting can upset the body's electrolyte balance, leading to potentially life-threatening problems, such as heart beat abnormalities (arrhythmia). The risk of dehydration increases the longer that symptoms are present. Signs of dehydration include a dry mouth, increased or excessive thirst, or scanty urination.

Symptoms that do not clear up within a week may point to an infection or disorder more serious than gastroenteritis. Symptoms of great concern include a fever of 102°F (38.9°C) or above, blood or mucus in the diarrhea, blood in the vomit, and severe abdominal pain or swelling. Persons experiencing these symptoms should seek prompt medical attention.

Diagnosis

The symptoms of gastroenteritis are usually sufficient for identifying the illness. Unless there are complications or there is an outbreak that affects several people, identifying the specific cause of the illness is not a priority. However, if it is necessary to identify the infectious agent, a stool sample will be collected and analyzed for the presence of viruses, disease-causing (pathogenic) bacteria, or parasites.

Treatment

Gastroenteritis is a self-limiting illness that will resolve by itself. Symptoms of uncomplicated gastroenteritis can be relieved with adjustments in diet, herbal remedies, and homeopathy. An infusion of meadowsweet (Filipendula ulmaria) may be effective in reducing nausea and stomach acidity. Once the worst symptoms are relieved, slippery elm (Ulmus fulva) can be used to calm the digestive tract.

The homeopathic remedies Arsenicum album, ipecac, and Nux vomica are also believed to relieve the symptoms of gastroenteritis. In Chinese herbal medicine, the patent remedies Po Chai and Pill Curing can be effective for relieving nausea and diarrhea.

Supplementing the bacteria that are beneficial to a person's health (probiotics) is recommended during the recovery phase of gastroenteritis. Specifically, live cultures of Lactobacillus acidophilus are said to be effective in soothing the digestive tract and returning the intestinal flora to normal. In fact, in 2002, a new study found it was reasonably effective in treating children with acute infectious diarrhea. L. acidophilus is found in live-culture yogurt and in capsule or powder form at health food stores. Castor oil packs applied to the abdomen can reduce inflammation, spasms, and discomfort.

It is important to stay hydrated and nourished during a bout of gastroenteritis. In the absence of dehydration, it should be sufficient to drink generous amounts of nonalcoholic fluids, such as water or juice. Caffeine should be avoided, since it increases urine output.

The traditional BRAT diet—bananas, rice, apple-sauce, and toast—is tolerated by the tender gastrointestinal system, but it is not particularly nutritious. Many, but not all, medical researchers recommend a diet that includes complex carbohydrates (rice, wheat, potatoes, bread, and cereal, for example), lean meats, yogurt, fruit, and vegetables. Milk and other dairy products shouldn't create problems if they are part of the normal diet. Fatty foods or foods with a lot of sugar should be avoided. These recommendations are based on clinical experience and controlled trials, but are not universally accepted.

Allopathic Treatment

Over-the-counter medications such as Pepto Bismol are useful in relieving the symptoms of gastroenteritis. These medications work by altering the intestine's ability to move or secrete spontaneously, by absorbing toxins and water, or by altering intestinal microflora. Some over-the-counter medicines use more than one element to treat symptoms, and this information should be included on the label.

If over-the-counter medications are ineffective, a doctor may prescribe a more powerful anti-diarrheal drug, such as motofen or lomotil. If pathogenic bacteria or parasites are found in the patient's stool sample, medications such as antibiotics will be prescribed.

Minimal to moderate dehydration is treated with oral rehydrating solutions that contain glucose and electrolytes. These solutions are commercially available under names such as Naturalyte, Pedialyte, Infalyte, and Rehydralyte. If vomiting prevents the patient from taking a full dose of solution, he or she may better tolerate fluid taken in small, frequent amounts. Should oral rehydration fail or severe dehydration occur, medical treatment in the form of intravenous (IV) therapy is required. IV therapy can be followed with oral rehydration as the patient's condition improves. Once normal hydration is achieved, the patient can return to a regular diet.

Sometimes, a child's dehydration is so severe that it requires hospitalization with IV therapy. However, a study published in 2002 informed pediatricians that often, rapid intravenous rehydration and rapid nasogastric hydration in the emergency department are safe and effective alternatives to hospitalization for many children with viral gastroenteritis. Not only does this save money, it also saves a child the more frightening experience of being in a hospital overnight and the routine laboratory testing he or she would endure in the hospital setting.

Expected Results

Gastroenteritis usually clears up within two to three days and there are no long-term effects. If dehydration occurs, recovery is extended by a few days.

Prevention

Gastroenteritis can be avoided by practicing good hygiene, which includes washing hands thoroughly after using the bathroom or coming in contact with an infected person, using disinfectants to clean areas the infected person has come in contact with, and washing infected linens in hot water. Making sure that food is well-cooked and unspoiled can prevent bacterial gastroenteritis, but may not be effective against viral gastroenteritis.

Resources

Books

Hoffman, David. The Complete Illustrated Herbal. New York: Barnes & Noble, 1999.

Midthun, Karen, and Albert Z. Kapikian. "Viral Gastroenteritis." In Gastrointestinal and Hepatic Infections, edited by Christina Surawicz and Robert L. Owen. Philadelphia: W.B. Saunders, 1995.

Periodicals

Burke, Michael G."For Gastroenteritis, Rehydration But no Hospitalization." Contemporary Pediatrics (June 2002): 125.

Gorbach, Sherwood L. "Efficacy of Lactobacillus in Treatment of Acute Diarrhea." Nutrition Today 31, no. 6 (December 1996): 195.

Hart, C. Anthony, and Nigel A. Cunliffe. "Viral Gastroenteritis." Current Opinion in Infectious Diseases 10 (1997): 408.

Moss, Peter J., and Michael W. McKendrick. "Bacterial Gastroenteritis." Current Opinion in Infectious Diseases 10 (1997): 402.

Van Niel, Cornelius W., and others. "Lactobacillus Therapy for Acute Infectious Diarrhea in Children: A Meta-analysis." Pediatrics (April 2002): 678.

[Article by: Paula Ford-Martin; Teresa G. Odle]

Definition

Gastroenteritis is an inflammation of the digestive tract, particularly the stomach, and large and small intestines. Viral and bacterial gastroenteritis are intestinal infections associated with symptoms of diarrhea, abdominal cramps, nausea, and vomiting.

Description

Gastroenteritis is an uncomfortable and inconvenient ailment, but is rarely life-threatening in the United States and other developed nations. Viral gastroenteritis is frequently referred to as the stomach or intestinal flu, although the influenza virus is not associated with this illness.

Demographics

Viral gastroenteritis is one of the most common acute (sudden-onset) illnesses in the United States, with millions of cases reported annually. Each year, an estimated 220,000 children younger than age five are hospitalized with gastroenteritis symptoms. Of these children, 300 die as a result of severe diarrhea and dehydration. In developing nations, diarrheal illnesses are a major source of mortality.

Causes and Symptoms

Causes

Gastroenteritis is caused by the ingestion of viruses, certain bacteria, or parasites. Food that has spoiled may also cause illness. Young children may develop signs and symptoms of gastroenteritis as a reaction to a new food.

VIRAL INFECTION. Viral infection is the most common cause of gastroenteritis. Viral gastroenteritis is highly contagious and can be spread through close contact with an infected person. Exposure also can occur through the fecal-oral route, such as by consuming foods or beverages contaminated by fecal material related to poor sanitation or poor hygiene, or by touching contaminated surfaces and then touching the mouth and ingesting the germs. The four types of viruses that cause most viral gastroenteritis include rotavirus, adenovirus, calicivirus, and astrovirus.

Typically, children ages three to 15 months are more vulnerable to rotaviruses, the most significant cause of acute watery diarrhea. Outbreaks of diarrhea caused by rotaviruses are common during the winter and early spring months, especially in child care centers. Symptoms in children last for three to eight days, and occur one to two days after exposure to the virus. Worldwide, rotaviruses are estimated to cause 800,000 deaths annually in children under five years of age. For this reason, much research has gone into developing a vaccine to protect children from this virus. Adults can be infected with rotaviruses, but these infections typically have minimal or no symptoms.

Children under age two are more susceptible to adenovirus serotypes 40 and 41. Vomiting and diarrhea symptoms occur about one week after exposure to the virus.

Calciviruses cause infection in people of all ages. This family of viruses includes the noroviruses (such as the Norwalk virus) and the sapoviruses (such as the sapporo virus). Calciviruses are transmitted from person-to-person contact, as well as through contaminated water or food. These viruses are the most likely to produce vomiting as a major symptom. Muscle aches also are common symptoms. The symptoms usually appear within one to three days after exposure to the virus.

Astrovirus primarily infects infants, young children, and the elderly. This virus is most active during the winter months. Symptoms of vomiting and diarrhea appear within one to three days after exposure to the virus.

BACTERIAL AND PARASITIC INFECTIONS. Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking water, or contaminated food (conditions common in developing nations). Natural or man-made disasters can worsen underlying problems in sanitation and food safety.

In developed nations, including the United States, bacterial gastroenteritis may result from contaminated water supplies, improperly processed or preserved foods, or person-to-person contact in places such as child-care centers. The modern food production system potentially exposes millions of people to disease-causing bacteria through its intensive production and distribution methods. Common types of bacterial gastroenteritis can be linked to Salmonella and Campylobacter bacteria. However, Escherichia coli (E. coli) 0157:H7 and Listeria monocytogenes, bacterial causes of food borne illnesses, have caused increased concern in developed nations.

Cholera and Shigella remain two diseases of great concern in developing countries, and research to develop long-term vaccines against them is underway. Shigella bacteria are dangerous because they attack the intestinal wall and cause bleeding ulcers.

Parasitic infections that cause gastroenteritis are most commonly caused by Giardia, which is easily spread through contaminated water and human contact. Cryptosporidium is another common parasitic organism that causes the symptoms of gastroenteritis.

Symptoms

Gastroenteritis symptoms include nausea and vomiting, watery diarrhea, and abdominal pain and cramps. These symptoms are sometimes accompanied by bloating, low fever, chills, headache, and overall tiredness or weakness. Gastroenteritis symptoms typically last two to three days, but some viruses may last up to a week.

Infants, young children, the elderly, and anyone with an underlying disease are more vulnerable to complications of gastroenteritis. The greatest danger presented by gastroenteritis is dehydration. The loss of fluids through diarrhea and vomiting can upset the body's electrolyte balance, leading to potentially life-threatening problems such as heart beat abnormalities (arrhythmia). The risk of dehydration increases as symptoms become prolonged. Untreated, severe dehydration can be life threatening. Dehydration should be suspected if symptoms of a dry mouth, increased or excessive thirst, or decreased urination are experienced.

When to Call the Doctor

If symptoms do not resolve within one week, an infection or disorder more serious than gastroenteritis may be involved. Prompt medical attention is required if the child has any of these symptoms:

• a high fever of 102°F (38.9°C) or above
• blood or mucus in the diarrhea
• blood in the vomit
• bloody stools or black stools
• confusion
• severe abdominal pain or swelling
• inability to keep liquids down

If a child has the following symptoms, the parent should contact the child's pediatrician:

• diarrhea or vomiting that wakes the child during the night
• persistent or severe diarrhea or vomiting
• dehydration symptoms, including dry mouth, increased or excessive thirst, few or no tears when crying, decreased urination, dark yellow urine, irritability, low energy, lightheadedness or fainting, severe weakness, and sunken abdomen, eyes, and cheeks
• no improvement in symptoms after 36 hours

Diagnosis

A usual bout of gastroenteritis should not require a visit to the doctor. However, medical treatment is essential if symptoms worsen or if the child has any symptoms of dehydration.

A physician makes the diagnosis of gastroenteritis based on the presence of symptoms and after performing a medical examination. Unless there is an outbreak affecting several people or complications are encountered in a particular case, identifying the specific cause of the illness is not a priority. However, if identification of the infectious agent is required, a stool sample will be collected and analyzed for the presence of rotavirus, disease-causing (pathogenic) bacteria, or parasites.

When symptoms continue even after treatment or to rule out the presence of other illnesses with similar symptoms, the diagnostic evaluation may include blood tests, a hydrogen breath test, or an x ray of the bowel, called a barium enema. Endoscopic tests such as a colonoscopy or sigmoidoscopy may be performed. An endoscopic test is an internal examination of the colon using a flexible instrument (sigmoidoscope or colonoscope) inserted through the anus. When symptoms persist, a nutritional assessment, performed by a registered dietitian, may be included in the child's diagnostic evaluation.

Treatment

Gastroenteritis is a self-limiting illness that will resolve by itself. Acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin) should be used sparingly for relief of discomfort. Parents should ask the child's doctor for specific guidelines. Should pathogenic bacteria or parasites be identified in the patient's stool sample, medications such as antibiotics will be prescribed. Over-the-counter antidiarrheal medications such as Imodium should not be given to the child unless advised by the child's doctor, as these drugs may make it more difficult for the child's body to eliminate the virus.

An adequate intake of liquids and oral rehydrating solutions may be enough to treat mild dehydration. More severe dehydration requires medical treatment with intravenous (IV) fluids and may require hospitalization. IV therapy can be followed with oral rehydration as the patient's condition improves. Once normal hydration is achieved and symptoms have cleared, the patient can resume a regular diet.

Nutritional Concerns

It is important for the child to stay hydrated and nourished during a bout of gastroenteritis. Formula feeding and breastfeeding should continue as normal. If dehydration is absent, drinking generous amounts of fluids, such as water or juice, is adequate. Caffeine should be avoided since it increases urine output and can contribute to or worsen dehydration. Dairy products, sugary beverages and foods, highly seasoned foods, and fatty or fried foods should be avoided until symptoms have cleared.

When diarrhea and vomiting symptoms have subsided, plain foods can be given. The traditional BRAT diet—bananas, rice, applesauce, and toast—is tolerated by the tender gastrointestinal system. Other foods can be gradually reintroduced into the diet once the child is symptom-free.

Minimal to moderate dehydration can be treated by giving the child generous amounts of fluids, including water, clear liquids, and oral rehydrating solutions containing glucose and electrolytes. Oral rehydrating solutions—including brands such as Pedialyte, Infalyte, Ceralyte, and Oralyte—are available at most grocery and drug stores. They are essential for replacing fluids, minerals, and salts lost from diarrhea or vomiting, and should be given when diarrhea or vomiting first occur.

Small sips of water, clear liquids, or ice chips are usually tolerated better than a large glass of liquid given all at once.

If the water supply is thought to be contaminated because of a recent storm or other reason, the water should be boiled or bottled water should be given.

The Centers for Disease Control and Prevention (CDC) recommends that families with infants and young children keep a supply of oral rehydration solution (two bottles or packages) at home at all times. However, it is important to make sure that the product has not expired before giving it to the child. Parents and caregivers should follow usage directions on the package.

Oral rehydrating solutions are formulated based on physiological properties. Fluids that are not based on these properties—such as cola, apple juice, broth, and sports beverages—are not recommended to treat dehydration.

Alternative Treatment

Alternative and complementary therapies include approaches that are considered to be outside the mainstream of traditional health care. Symptoms of uncomplicated gastroenteritis can be relieved with adjustments in diet and homeopathy.

Probiotics, bacteria that are beneficial to a person's health, are recommended during the recovery phase of gastroenteritis. Specifically, live cultures of Lactobacillus acidophilus are said to be effective in soothing the digestive tract and returning the intestinal flora to normal. L. acidophilus is found in live-culture yogurt, as well as in capsule or powder form at health food stores. The use of probiotics has some support in the medical literature. Castor oil packs applied to the abdomen can reduce inflammation and also lessen spasms or discomfort.

Before using any alternative remedy, it is important for the parent/caregiver and child to learn about the therapy, its safety and effectiveness, and potential side effects. Although some remedies are beneficial, others may be harmful to certain patients. Dietary supplements should not be used as a substitute for medical therapies prescribed by a doctor. Parents should discuss these alternative treatments with the child's doctor to determine the techniques and remedies that may be beneficial for the child.

Prognosis

For most people, gastroenteritis is not a serious illness. It typically resolves within two to three days and there are usually no long-term effects. If dehydration occurs, recovery is extended by a few days. Gastroenteritis is not an anatomical or structural defect, nor is it an identifiable physical or chemical disorder.

Prevention

A few steps can be taken to avoid gastroenteritis. Thorough hand washing is the most effective way to prevent the fecal-oral transmission of certain viruses, especially rotaviruses. People should wash their hands frequently, especially after using the bathroom and before eating. Child-care providers and caregivers should wash their hands after diapering a child and before preparing, serving, or eating, food. The child's hands also should be washed after every diaper change. Separate towels or disposable paper towels should be used to dry hands. Clean bathroom surfaces, disinfected toys, and prompt washing of soiled clothes in hot water also help prevent the spread of infectious germs.

Ensuring that food is prepared safely well-cooked and unspoiled can prevent bacterial gastroenteritis, but may not be effective against viral gastroenteritis. All kitchen utensils, counters, or cutting boards that come in contact with raw meat, especially poultry, should be washed with hot water and a chlorine bleach-based cleaner to prevent the spread of harmful bacteria. Meats should be refrigerated as soon as possible after bringing them home from the grocery store, and cooked leftovers should be refrigerated as soon as possible after a meal to prevent spoilage.

Consuming contaminated food or water can cause gastroenteritis when traveling to other countries. To reduce the risk, travelers should use bottled water for drinking and brushing teeth, and avoid ice (it may be made with contaminated water) and raw foods, including peeled fruit, raw vegetables, and salads.

Research is underway involving vaccines that will decrease the risk of rotavirus infection, especially among infants and young children.

Parental Concerns

Parents should reinforce with the child that gastroenteritis is not a serious condition and that symptoms usually subside in a few days. It is most important to prevent dehydration by following the recommendations listed previously. Parents should assure that the child gets adequate rest; the child should be kept home from school or day care until the symptoms have cleared. The child may be contagious before the onset of diarrhea and a few days after the diarrhea has ended. To prevent the spread of infection among family members, soiled clothing or bedding should be washed in hot water immediately, hands must be washed frequently, there should be no sharing of utensils or cups used by the child, and toys and bathroom surfaces should be cleaned with a chlorine-based cleaner.

See also Food poisoning.

Resources

Periodicals

DeWit, Matty A.S., et. al. "Risk Factors for Nororvirus, Sappporo-like Virus, and Group A Rotavirus Gastroenteritis." Emerging Infectious Diseases 9, no. 12 (December, 2003): 1563–70. Available online at: www.cdc.gov/eid.

Organizations

American College of Gastroenterology (ACG). P.O. Box 3099, Alexandria, VA 22302. (703) 820-7400. Web site: www.acg.gi.org/patientinfo.

American Gastroenterological Association. 4930 Del Ray Ave., Bethesda, MD 20814. (301) 654-2055. Patient Information Resources. Web site: www.gastro.org/generalPublic.html.

Centers for Disease Control and Prevention. 1600 Clifton Rd., Atlanta, GA 30333. (800) 311-3435 or (404) 639-3534. Web site: www.cdc.gov.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389. Web site: www.niddk.nih.gov.

Web Sites

"Gastroenteritis." September 24, 2003. Mayo Clinic. Available online at: www.mayoclinic.com/invoke.cfm?id=DS00085.

"Gastrointestinal Infections and Diarrhea." KidsHealth. Nemours Foundation, February 2002. Available online at: www.kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&os=107&cat_id=137&article_id=22887.

"Viral Gastroenteritis." [cited August 20, 2001]. Centers for Disease Control. Available online at: www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm.

[Article by: Julia Barrett Angela M. Costello]

For more information on gastroenteritis, visit Britannica.com.

Inflammation of the lining of the stomach and intestine. The clinical manifestations are vomiting and diarrhea. See also gastritis.

• canine hemorrhagic g. — an acute syndrome of vomiting and bloody diarrhea with dehydration and marked hemoconcentration. If not treated vigorously, it may lead to circulatory failure and death in a short time. The cause is unknown.
• eosinophilic g. — a chronic segmental disease of the alimentary tract characterized by a variety of signs depending on the location of the lesion but including vomiting, or diarrhea or melena or hematochezia. Occurs in dogs, particularly German shepherd dogs, rarely in cats, and in horses. Diarrhea, weight loss and a protein-losing enteropathy result. A hypersensitivity to ingested allergens is the suggested cause. The diagnostic lesion is the aggregation of eosinophils in the intestinal wall. See also eosinophilic gastritis.
• transmissible viral g. of pigs — see transmissible gastroenteritis.

Gastroenteritis
Classification and external resources
ICD-10	A02.0, A08., A09., J10.8, J11.8, K52.
ICD-9	009.0, 009.1, 558
DiseasesDB	30726
eMedicine	emerg/213
MeSH	D005759

Look up gastroenteritis in Wiktionary, the free dictionary.

Gastroenteritis (also known as gastro, gastric flu, tummy bug in the United Kingdom, and stomach flu, although unrelated to influenza) is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine (see also gastritis and enteritis) and resulting in acute diarrhea. The inflammation is caused most often by an infection from certain viruses or less often by bacteria, their toxins, parasites, or an adverse reaction to something in the diet or medication. Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year,^[1] and is a leading cause of death among infants and children under 5.^[2]

At least 50% of cases of gastroenteritis due to foodborne illness are caused by norovirus.^[3] Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus^[4] and astrovirus.

Different species of bacteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, and others. Some sources of the infection are improperly prepared food, reheated meat dishes, seafood, dairy, and bakery products. Each organism causes slightly different symptoms but all result in diarrhea. Colitis, inflammation of the large intestine, may also be present.

Risk factors include consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation. It is also common for river swimmers to become infected during times of rain as a result of contaminated runoff water.^[5]

Contents 1 Classification 1.1 Bacterial gastroenteritis 1.2 Viral gastroenteritis 2 Symptoms and signs 3 Diagnosis 4 Management 4.1 Rehydration 4.2 Diet 4.3 Pharmacologic therapy 4.4 Alternative medications 5 Complications 6 Epidemiology 7 History 8 See also 9 Notes 10 External links

Classification

Gastroenteritis viruses: A = rotavirus, B = adenovirus, C = Norovirus and D = Astrovirus. The virus particles are shown at the same magnification to allow size comparison.

Infectious gastroenteritis is caused by a wide variety of bacteria and viruses.

It is important to consider infectious gastroenteritis as a diagnosis per exclusionem. A few loose stools and vomiting may be the result of systemic infection such as pneumonia, septicemia, urinary tract infection and even meningitis. Surgical conditions such as appendicitis, intussusception and, rarely, even Hirschsprung's disease may mislead the clinician. Endocrine disorders (e.g. thyrotoxicosis and Addison's disease) are disorders that can cause diarrhea. Also, pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should be excluded as possibilities.^[6]

Bacterial gastroenteritis

For a list of bacteria causing gastroenteritis, see above. Pseudomembranous colitis is an important cause of diarrhea in patients often recently treated with antibiotics.

If gastroenteritis in a child is severe enough to require admission to a hospital, then it is important to distinguish between bacterial and viral infections. Bacteria, Shigella and Campylobacter, for example, and parasites like Giardia can be treated with antibiotics.

Viral gastroenteritis

Viruses causing gastroenteritis include rotavirus, norovirus, adenovirus and astrovirus. Viruses do not respond to antibiotics and infected children usually make a full recovery after a few days.^[7] Children admitted to hospital with gastroenteritis routinely are tested for rotavirus A to gather surveillance data relevant to the epidemiological effects of rotavirus vaccination programs.^[8][9] These children are routinely tested also for norovirus, which is extraordinarily infectious and requires special isolation procedures to avoid transmission to other patients. Other methods, electron microscopy and polyacrylamide gel electrophoresis, are used in research laboratories.^[10][11]

Symptoms and signs

Gastroenteritis often involves stomach pain or spasms, diarrhea and/or vomiting, with noninflammatory infection of the upper small bowel, or inflammatory infections of the colon.^{[1][6][12][13]}

It's usually of acute onset, normally lasting 1–6 days, and is self-limiting.

• Nausea and vomiting
• Diarrhea
• Loss of appetite
• Headaches
• Abnormal flatulence
• Abdominal pain
• Abdominal cramps
• Bloody stools (dysentery - suggesting infection by amoeba, Campylobacter, Salmonella, Shigella or some pathogenic strains of Escherichia coli^[4])
• Fainting and Weakness

The main contributing factors include poor feeding in infants. Diarrhea is common, and may be followed by vomiting. Viral diarrhea usually causes frequent watery stools, whereas blood stained diarrhea may be indicative of bacterial colitis. In some cases, even when the stomach is empty, bile can be vomited up.

A child with gastroenteritis may be lethargic, suffer lack of sleep, run a low fever, have signs of dehydration (which include dry mucous membranes), tachycardia, reduced skin turgor, skin color discoloration, sunken fontanelles, sunken eyeballs, darkened eye circles, glassy eyes, poor perfusion and ultimately shock.

Diagnosis

No specific diagnostic tests are required in most patients with simple gastroenteritis. If symptoms including fever, bloody stool and diarrhea persist for two weeks or more, examination of stool for Clostridium difficile may be advisable along with cultures for bacteria including Salmonella, Shigella, Campylobacter and Enterotoxic Escherichia coli. Microscopy for parasites, ova and cysts may also be helpful.^{[citation needed]}

Management

The objective of treatment is to replace lost fluids and electrolytes. Oral rehydration is the preferred treatment of fluid and electrolyte losses caused by diarrhea in children with mild to moderate dehydration.^[14]

Rehydration

The primary treatment of gastroenteritis in both children and adults is rehydration, i.e., replenishment of water and electrolytes lost in the stools. Depending on the degree of dehydration, this can be done by giving the person oral rehydration therapy (ORT) or through intravenous delivery.^[15] Complex-carbohydrate-based ORS such as those made from wheat or rice have been found to be superior to simple sugar-based ORS.^[16]

Sugary drinks such as soft drinks and fruit juice are not recommended for gastroenteritis in children under 5 years of age as they may make the diarrhea worse.^[17] Plain water may be used if specific ORS are unavailable or not palatable.^[17]

Diet

Centers for Disease Control and Prevention (CDC) recommends that breastfed infants continue to be nursed on demand and that formula-fed infants should continue their usual formula immediately upon rehydration with ORS in amounts sufficient to satisfy energy and nutrient requirements and at the usual concentration. Lactose-free or lactose-reduced formulas usually are not necessary.^[18]

Children receiving semisolid or solid foods should continue to receive their usual diet during episodes of diarrhea. Foods high in simple sugars should be avoided because the osmotic load might worsen diarrhea; therefore, soft drinks (carbonated or flat), juice, gelatin desserts, and other high simple sugar foods should be avoided.^[18] The practice of withholding food is not recommended and immediate normal feeding is encouraged.^[19]

The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.^[20]

Pharmacologic therapy

Gastroenteritis is usually an acute and self-limited disease that does not require pharmacologic therapy.^[17]

Antibiotics

Antibiotics are usually not useful for gastroenteritis, although they are sometimes used if symptoms are severe or a susceptible bacterial cause is isolated or suspected.^{[citation needed]} If antibiotics are decided on, a fluoroquinolone or macrolide is often used.^[12]

Pseudomembranous colitis, usually caused by antibiotics use, is managed by discontinuing the causative agent and treating with either metronidazole or vancomycin.^{[1][6][12][13]}

Antimotility agents

Antimotility drugs have a theoretical risk of causing complications, clinical experience however has shown this to be unlikely.^[6][12] They are thus discouraged in people with bloody diarrhea or diarrhea complicated by a fever.^[1]

Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea.^[12] Loperamide is not recommended in children as it may cross the blood brain barrier due to its immaturity and cause toxicity.

Bismuth subsalicylate (BSS), an insoluble complex of trivalent bismuth and salicylate, can be used in mild-moderate cases.^[6][12]

Antiemetic drugs

Antiemetic drugs may be helpful for vomiting in children. Ondansetron has some utility with a single dose associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.^[21][22] Metoclopramide also might be helpful.^[23]

Alternative medications

Probiotics

Some probiotics have been shown to be beneficial in preventing and treating various forms of gastroenteritis.^[20] Fermented milk products (such as yogurt) also reduce the duration of symptoms.^[24]

Zinc

The World Health Organization recommends that infants and children receive a dietary supplement of zinc for up to two weeks after onset of gastroenteritis.^[25] A 2009 trial however did not find any benefit from supplementation.^[26]

Complications

Dehydration is a common complication of diarrhea. It can be made worse with the withholding fluids or the administration of juice / soft drinks.^[27]

Malabsorption of lactose, the principal sugar in milk, may occur. It may increase the diarrhea,^[28] however, is not a reason to discontinue breastfeeding.

Epidemiology

In 1980 gastroenteritis caused 4.6 million deaths in children with most of these occurring in the third world.^[13] lack of adequate safe water and sewage treatment has contributed to the spread of infectious gastroenteritis. Current death rates have come down significantly to approximately 1.5 million deaths annually in the year 2000, largely due to the global introduction of oral rehydration therapy.^[29]

The incidence in the developed world is as high as 1-2.5 cases per child per year^{[citation needed]} and is a major cause of hospitalization in this age group.

Age, living conditions, hygiene and cultural habits are important factors. Aetiological agents vary depending on the climate. Furthermore, most cases of gastroenteritis are seen during the winter in temperate climates and during summer in the tropics.^[13]

History

Before the 20th century, the term "gastroenteritis" was not commonly used. What would now be diagnosed as gastroenteritis may have instead been diagnosed more specifically as typhoid fever or "cholera morbus", among others, or less specifically as "griping of the guts", "surfeit", "flux", "colic", "bowel complaint", or any one of a number of other archaic names for acute diarrhea.^[30] Historians, genealogists, and other researchers should keep in mind that gastroenteritis was not considered a discrete diagnosis until fairly recently.

U.S. President Zachary Taylor died of gastroenteritis on July 9, 1850.^{[citation needed]}

See also

• Diarrhea
• 1984 Rajneeshee bioterror attack
• Food poisoning
• Eosinophilic gastroenteritis
• Hemorrhagic gastroenteritis
• Cholera
• Dysentery
• Infectious diarrhea
• Traveler's diarrhea
• Wilderness diarrhea
• Pseudomembranous colitis
• Rotavirus
• Cryptosporidium

Notes

1. ^ ^{a b c d} Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 2005. ISBN 0-07-139140-1.
2. ^ King CK, Glass R, Bresee JS, Duggan C (2003). "Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy". MMWR Recomm Rep 52 (RR-16): 1–16. PMID 14627948. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm. 
3. ^ "Norovirus: Technical Fact Sheet". National Center for Infectious Diseases, CDC. http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-factsheet.htm. 
4. ^ ^{a b} Murray PR, Pfaller MA, Rosenthal KS. Medical Microbiology. Mosby, 2005. ISBN 0323033032.
5. ^ Seven Surfing Sicknesses.
6. ^ ^{a b c d e} The Oxford Textbook of Medicine. Edited by David A. Warrell, Timothy M. Cox and John D. Firth with Edward J. Benz, Fourth Edition (2003), Oxford University Press, ISBN 0-19-262922-0
7. ^ Haffejee IE (1991). "The pathophysiology, clinical features and management of rotavirus diarrhoea". Q. J. Med. 79 (288): 289–99. PMID 1649479. 
8. ^ Patel MM, Tate JE, Selvarangan R, et al. (2007). "Routine laboratory testing data for surveillance of rotavirus hospitalizations to evaluate the impact of vaccination" (Subscription required). Pediatr. Infect. Dis. J. 26 (10): 914–9. doi:10.1097/INF.0b013e31812e52fd. PMID 17901797. 
9. ^ "The paediatric burden of rotavirus disease in Europe". Epidemiol. Infect. 134 (5): 908–16. 2006. doi:10.1017/S0950268806006091. PMID 16650331. 
10. ^ Beards GM (1988). "Laboratory diagnosis of viral gastroenteritis". Eur. J. Clin. Microbiol. Infect. Dis. 7 (1): 11–3. doi:10.1007/BF01962164. PMID 3132369. 
11. ^ Steel HM, Garnham S, Beards GM, Brown DW (1992). "Investigation of an outbreak of rotavirus infection in geriatric patients by serotyping and polyacrylamide gel electrophoresis (PAGE)". J. Med. Virol. 37 (2): 132–6. doi:10.1002/jmv.1890370211. PMID 1321223. 
12. ^ ^{a b c d e f} Sleisenger & Fordtran's Gastrointestinal and Liver Disease 7th edition, by Mark Feldman; Lawrence S. Friedman; and Marvin H. Sleisenger, ISBN 0-7216-8973-6, Hardback, Saunders, Published July 2002
13. ^ ^{a b c d} Mandell's Principles and Practices of Infection Diseases 6th Edition (2004) by Gerald L. Mandell MD, MACP, John E. Bennett MD, Raphael Dolin MD, ISBN 0-443-06643-4 · Hardback · 4016 Pages Churchill Livingstone
14. ^ "Practice parameter: the management of acute gastroenteritis in young children. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis". Pediatrics 97 (3): 424–35. 1996. PMID 8604285. 
15. ^ "BestBets: Fluid Treatment of Gastroenteritis in Adults". http://www.bestbets.org/bets/bet.php?id=1039. 
16. ^ Gregorio GV, Gonzales ML, Dans LF, Martinez EG (2009). "Polymer-based oral rehydration solution for treating acute watery diarrhoea". Cochrane Database Syst Rev (2): CD006519. doi:10.1002/14651858.CD006519.pub2. PMID 19370638. 
17. ^ ^{a b c} "Diarrhoea and vomiting in children under 5". http://www.nice.org.uk/Guidance/CG84#summary. 
18. ^ ^{a b} "Managing Acute Gastroenteritis Among Children: Oral Rehydration, Maintenance, and Nutritional Therapy". http://www.cdc.gov/mmwR/preview/mmwrhtml/rr5216a1.htm. 
19. ^ "BestBets: Gradual introduction of feeding is no better than immediate normal feeding in children with gastro-enteritis". http://www.bestbets.org/bets/bet.php?id=390. Retrieved on December 6,2008. 
20. ^ ^{a b} King CK, Glass R, Bresee JS, Duggan C (November 2003). "Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy". MMWR Recomm Rep 52 (RR-16): 1–16. PMID 14627948. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm. 
21. ^ DeCamp LR, Byerley JS, Doshi N, Steiner MJ (September 2008). "Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis". Arch Pediatr Adolesc Med 162 (9): 858–65. doi:10.1001/archpedi.162.9.858. PMID 18762604. 
22. ^ Mehta S, Goldman RD (2006). "Ondansetron for acute gastroenteritis in children". Can Fam Physician 52 (11): 1397–8. PMID 17279195. http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=17279195. 
23. ^ Alhashimi D, Al-Hashimi H, Fedorowicz Z (2009). "Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents". Cochrane Database Syst Rev (2): CD005506. doi:10.1002/14651858.CD005506.pub4. PMID 19370620. 
24. ^ "Does yogurt decrease acute diarrhoeal symptoms in children with acute gastroenteritis". http://www.bestbets.org/bets/bet.php?id=1000. 
25. ^ Rehydrate.org: Zinc Supplementation
26. ^ Patel A, Dibley MJ, Mamtani M, Badhoniya N, Kulkarni H (2009). "Zinc and copper supplementation in acute diarrhea in children: a double-blind randomized controlled trial". BMC Med 7: 22. doi:10.1186/1741-7015-7-22. PMID 19416499. 
27. ^ "Diarrhoea and vomiting in children under 5". http://guidance.nice.org.uk/CG84. 
28. ^ Arya SC (1984). "Rotaviral infection and intestinal lactase level". J. Infect. Dis. 150 (5): 791. PMID 6436397. 
29. ^ Victora CG, Bryce J, Fontaine O, Monasch R (2000). "Reducing deaths from diarrhoea through oral rehydration therapy". Bull. World Health Organ. 78 (10): 1246–55. PMID 11100619. 
30. ^ Rudy's List of Archaic Medical Terms

External links

• "NHS Direct: Gastroenteritis". http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=172. Retrieved on 2007-04-12. 
• "eMedicine Health:Gastroenteritis". http://www.emedicinehealth.com/gastroenteritis/article_em.htm. Retrieved on 2007-04-12. 
• "The World Health Organisation: Diarrhoea". http://www.who.int/topics/diarrhoea/en/. Retrieved on 2007-04-12. 
• Gastroenteritis: First aid from the Mayo Clinic
• "About.com: Seasonal Flu vs. Stomach Flu". http://coldflu.about.com/od/flumisconceptions/f/stomachflu.htm. Retrieved on 2007-04-12. 

v • d • e Digestive system · Digestive disease · Gastroenterology (primarily K20-K93, 530-579) Upper GI tract Esophagus Esophagitis (Candidal) · rupture (Boerhaave syndrome, Mallory-Weiss syndrome) · UES (Zenker's diverticulum) · LES (Barrett's esophagus) · Esophageal motility disorder (Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD) · Esophageal stricture · Megaesophagus Stomach Gastritis (Atrophic, Ménétrier's disease, Gastroenteritis) · Peptic (gastric) ulcer (Cushing ulcer, Dieulafoy's lesion) · Dyspepsia · Pyloric stenosis · Achlorhydria · Gastroparesis · Gastroptosis · Portal hypertensive gastropathy · Gastric antral vascular ectasia · Gastric dumping syndrome · Gastric volvulus Intestinal/ enteropathy Small intestine/ (duodenum/jejunum/ileum) Enteritis (Duodenitis, Jejunitis, Ileitis) — Peptic (duodenal) ulcer (Curling's ulcer) — Malabsorption: Coeliac · Tropical sprue · Blind loop syndrome · Whipple's · Short bowel syndrome · Steatorrhea · Milroy disease Large intestine (appendix/colon) Appendicitis · Colitis (Pseudomembranous, Ulcerative, Ischemic, Microscopic, Collagenous, Lymphocytic) · Functional colonic disease (IBS, Intestinal pseudoobstruction/Ogilvie syndrome) — Megacolon/Toxic megacolon · Diverticulitis/Diverticulosis Large and/or small Enterocolitis (Necrotizing) · IBD (Crohn's disease) — vascular: Abdominal angina · Mesenteric ischemia · Angiodysplasia — Bowel obstruction: Ileus · Intussusception · Volvulus · Fecal impaction — Constipation · Diarrhea (Infectious) Rectum Proctitis (Radiation proctitis) · Proctalgia fugax · Rectal prolapse Anus Anal fissure/Anal fistula · Anal abscess  · Anal dysplasia  · Pruritus ani Accessory Liver Hepatitis (Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis) · Cirrhosis (PBC) · Fatty liver (NASH) · vascular (Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver) · Alcoholic liver disease · Liver failure (Hepatic encephalopathy, Acute liver failure) · Liver abscess (Pyogenic, Amoebic) · Hepatorenal syndrome · Peliosis hepatis Gallbladder Cholecystitis · Gallstones/Cholecystolithiasis · Cholesterolosis · Rokitansky-Aschoff sinuses · Postcholecystectomy syndrome Bile duct/ other biliary tree Cholangitis (PSC, Secondary sclerosing cholangitis, Ascending) · Cholestasis/Mirizzi's syndrome · Biliary fistula · Haemobilia · Gallstones/Cholelithiasis common bile duct (Choledocholithiasis, Biliary dyskinesia) Pancreatic Pancreatitis (Acute, Chronic, Hereditary) · Pancreatic pseudocyst · Exocrine pancreatic insufficiency · Pancreatic fistula Hernia Diaphragmatic: Congenital diaphragmatic · Hiatus — Abdominal hernia: Inguinal (Indirect, Direct) · Umbilical · Incisional · Femoral — Obturator hernia · Spigelian hernia · Internal hernia Peritoneal Peritonitis (Spontaneous bacterial peritonitis) · Hemoperitoneum · Pneumoperitoneum GI bleeding/BIS Upper (Hematemesis, Melena) · Lower (Hematochezia) See also: congenital and neoplasia

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v • d • e Inflammation Acute Plasma derived mediators Bradykinin · complement (C3, C5a, MAC) · coagulation (Factor XII, Plasmin, Thrombin) Cell derived mediators preformed: Lysosome granules · vasoactive amines (Histamine, Serotonin) synthesized on demand: cytokines (IFN-γ, IL-8, TNF-α, IL-1) · eicosanoids (Leukotriene B4, Prostaglandins) · Nitric oxide · Kinins Chronic Macrophage · Epithelioid cell · Giant cell · Granuloma Processes Traditional: Rubor · Calor · Tumor · Dolor (pain) · Functio laesa Modern: Acute-phase reaction/Fever · Vasodilation · Increased vascular permeability · Exudate · Leukocyte extravasation · Chemotaxis Specific types Nervous CNS (Encephalitis, Myelitis) · Meningitis (Arachnoiditis) · PNS (Neuritis) · eye (Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis) · ear (Otitis, Labyrinthitis, Mastoiditis) Cardiovascular Carditis (Endocarditis, Myocarditis, Pericarditis) · Vasculitis (Arteritis, Phlebitis, Capillaritis) Respiratory upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis) · lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis) · Mediastinitis Digestive mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis Integumentary Dermatitis (Folliculitis) · Hidradenitis Musculoskeletal Arthritis · Dermatomyositis · soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis) Osteochondritis: Osteitis (Spondylitis, Periostitis) · Chondritis Urinary Nephritis (Glomerulonephritis, Pyelonephritis) · Ureteritis · Cystitis · Urethritis Reproductive female: Oophoritis · Salpingitis · Endometritis · Parametritis · Cervicitis · Vaginitis · Vulvitis · Mastitis male: Orchitis · Epididymitis · Prostatitis · Balanitis · Balanoposthitis pregnancy/newborn: Chorioamnionitis · Omphalitis Endocrine Insulitis · Hypophysitis · Thyroiditis · Parathyroiditis · Adrenalitis

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