(Survival Manual/6. Medical/b) Disease/Stomach flu-grastroenteritis)
What Causes a “Stomach Flu”?
Although it’s commonly called stomach flu, gastroenteritis isn’t the same as influenza. Real flu (influenza) affects your respiratory system — your nose, throat and lungs. Gastroenteritis, on the other hand, attacks your intestines.
There are many causes of stomach flu, including bacteria such as E. coli, Campylobacter, Shigella, and Salmonella. Viruses can also cause stomach flu. Common stomach flu viruses include norovirus or Norwalk-like virus, adenovirus, rotavirus, calicivirus, and astrovirus. Stomach viruses are notorious for spreading rapidly because of poor hand washing.
While not as common, parasites such as giardia and cryptosporidium can cause severe diarrhea and dehydration. Water-borne parasites are common in underdeveloped parts of the world that have unsanitary water supplies. It is recommended that travelers stick to bottled water to avoid water-borne parasites — a potential cause of stomach flu.
Some foods may irritate your stomach and also cause gastroenteritis. Reaction to dairy products in someone with lactose intolerance is the most common example. Severe reactions to seafood is another example.
A lack of good hygiene can result in a stomach flu. For instance, improper hand washing after using the bathroom or after changing a baby’s diaper can spread the infectious bug from person to person.
How Is Stomach Flu Spread?
Stomach flu is highly contagious and can spread easily from person to person. These viruses often can be found in the stool or vomit of infected people. Transmission can occur in one of several ways, including:
• Eating foods or drinking liquids that are contaminated with a stomach flu virus.
• Having direct contact with another person who is infected and showing symptoms (for example, when caring for someone with the illness, or sharing food or eating utensils with someone who is ill)
• Touching surfaces or objects contaminated with a virus and then putting your hands in your mouth.
How does food get contaminated by gastroenteritis viruses?
Food is easily contaminated by people who prepare or handle food, and have viral gastroenteritis. Most often, failure to adequately wash hands or to clean off foods (for example, vegetables and fruits) that may be contaminated with sewage or untreated water, allow viral contamination that causes gastroenteritis. Additionally, the viruses can be viable for hours to days when they contaminate surfaces like handrails, doorknobs, and other items. This situation of contamination is essentially the same for many of the bacterial and other pathogens that can cause bacterial gastroenteritis.
Doctors call stomach flu “a family affair” because it is so highly contagious and usually goes through all members of a family.
People with symptoms of diarrhea, bloody diarrhea, nausea, or vomiting that last longer than 5 days, and often may have additional symptoms of fever (greater than 101 F), malaise, dehydration, sepsis, or additional symptoms, for this article, will not be considered to have gastroenteritis.
What are the symptoms of gastroenteritis?
The symptoms of gastroenteritis are:
• abdominal cramps, and
Not all affected individuals will develop all symptoms. Some people also may develop a mild fever of about 100 F (37.7 C). Most symptoms will resolve in about 2 to 5 days. Gastroenteritis may cause dehydration during this short time period, mainly in children or debilitated adults.
Medical Treatment of Gastroenteritis
You should realize that there isn’t much you can do about gastroenteritis or the stomach flu than simply treat the symptoms. You’re not going to die. Antibiotics won’t do anything to treat a stomach flu. If anything, antibiotics will make it worse because antibiotics kill the good bacteria in your intestinal tract, making you more susceptible to severe abdominal cramps. So, stock up on Gatorade, Tylenol, and a season or two of your favorite sitcom.
Stomach flus usually induce diarrhea which rapidly dehydrates the victim. To fight this, you need to stock up on both anti-diarrhea medicines (such as Imodium AD–an anti-spasmodic) and electrolyte solutions such as sports type drinks (Gatorade) can be used as oral rehydration solutions (ORSs) too. However dilute them about 50% with water, they have a lot of glucose in them which will exacerbate diarrhea symptoms.
If commercial oral hydration solutions are not available, you can make an emergency solution as follows:
• 1/2 teaspoon of salt
• 2 tablespoons honey, sugar, or rice powder
• 1/4 teaspoon potassium chloride (table salt substitute)
• 1/2 teaspoon trisodium citrate (can be replaced by baking soda)
• 1 quart of clean water
Items to have on hand at home
• Imodium AD is a trade name for Loperamide. It can be purchased generically for relatively little cost, at such places as warehouse stores. The generic (house brands) are just fine.
• Acetaminophen: Tylenol and/or Excedrin for pain killers.
• Either have a traditional glass thermometer for each person, or a digital thermometer with lots of disposable sleeves. The thermometers are a couple of bucks at most drug stores. The sleeves are a buck or so per hundred. Don’t cross-contaminate your patients.
It is a good idea to drink a lot of fluids. Diarrhea, a very common stomach flu symptom, causes dehydration very quickly. Even after drinking almost 8-10 glasses of water every day, the doctor said I was still dehydrated and short of electrolytes. So, get some Gatorade in bulk. Don’t fight the poop soup, just let it go. Your body needs to get rid of that stuff.
Simplifying your diet will help you cure gastroenteritis. Keep your diet down to clear liquids for the first 24 hours (broth, water, juices). If you feel better after 24 hours, then you can move on to foods like white rice, white bread, apple sauce, and bananas. Try to avoid citrus, greasy foods, dairy and tomato products, alcohol, coffee, and carbonated drinks. In other words, don’t go to McDonald’s.
If the stomach flu has you in a lot of pain, as acute gastroenteritis will, don’t be afraid to take pain killers. Pain killers with acetaminophen, like Tylenol and Excedrin are good because they don’t upset your stomach as easily as medicines like ibuprofen, Aleve, and aspirin. If you’re having way too much stomach pain, ask your doctor for Oxycodone. That’ll knock the pain out, help you sleep, and make everything really funny before you pass out.
A sufferer of gastroenteritis shouldn’t need to be told this, but get some rest. The reason doctors tell you to rest is because your nutritional intake is extremely low when you have a stomach flu, even if you’re slamming Campbell’s Soup like cans of Miller Lite at a baseball game. Your body is running on reserves and needs you to be lying down so you don’t waste protein and calories that could be used to fuel your immune system.
When a person becomes infected with stomach flu, the virus begins to multiply within the small intestine. After a minimum of 4 hours, but typically in 1 to 2 days (depending on the virus), symptoms appear.
Mayo Clinic Definition
Viral gastroenteritis is an intestinal infection marked by watery diarrhea, abdominal cramps, nausea or vomiting, and sometimes fever.
The most common way to develop viral gastroenteritis — often called stomach flu — is through contact with an infected person or ingestion of contaminated food or water. If you’re otherwise healthy, you’ll likely recover without complications. But for infants, older adults and people with compromised immune systems, viral gastroenteritis can be deadly.
There’s no effective treatment for viral gastroenteritis, so prevention is key. In addition to avoiding food and water that may be contaminated, thorough and frequent hand washing is your best defense.
Although it’s commonly called stomach flu, gastroenteritis isn’t the same as influenza. Real flu (influenza) affects your respiratory system — your nose, throat and lungs. Gastroenteritis, on the other hand, attacks your intestines, causing signs and symptoms such as:
• Watery, usually nonbloody diarrhea — bloody diarrhea usually means you have a different, more severe infection
• Abdominal cramps and pain
• Nausea, vomiting or both
• Occasional muscle aches or headache
• Low-grade fever
Depending on the cause, viral gastroenteritis symptoms may appear within one to three days after you’re infected and can range from mild to severe. Symptoms usually last just a day or two, but occasionally they may persist as long as 10 days.
Because the symptoms are similar, it’s easy to confuse viral diarrhea with diarrhea caused by bacteria such as salmonella and Escherichia coli (E. coli) or parasites such as giardia.
When to see a doctor
If you’re an adult, call your doctor if:
• You’re not able to keep liquids down for 24 hours
• You’ve been vomiting for more than two days
• You’re vomiting blood
• You’re dehydrated — signs of dehydration include excessive thirst, dry mouth, deep yellow urine or little or no urine, and severe weakness, dizziness or lightheadedness
• You notice blood in your bowel movements
• You have a fever above 104 F (40 C)
See your doctor right away if your child:
• Has a fever of 102 F (38.9 C) or higher
• Seems lethargic or very irritable
• Is in a lot of discomfort or pain
• Has bloody diarrhea
• Seems dehydrated — watch for signs of dehydration in sick infants and children by comparing how much they drink and urinate with how much is normal for them
If you have an infant, remember that while spitting up may be an everyday occurrence for your baby, vomiting is not. Babies vomit for a variety of reasons, many of which may require medical attention.
Call your baby’s doctor right away if your baby:
• Has vomiting that lasts more than several hours
• Hasn’t had a wet diaper in six hours
• Has bloody stools or severe diarrhea
• Has a sunken fontanel — the soft spot on the top of your baby’s head
• Has a dry mouth or cries without tears
• Is unusually sleepy, drowsy or unresponsive
You’re most likely to contract viral gastroenteritis when you eat or drink contaminated food or water, or if you share utensils, towels or food with someone who’s infected.
Some shellfish, especially raw or undercooked oysters, can make you sick. Contaminated drinking water also can cause viral diarrhea. But in many cases, the virus is passed through the fecal-oral route — that is, someone with the virus handles food you eat without washing his or her hands after using the bathroom.
A number of viruses can be the cause of gastroenteritis, including:
• Rotavirus. This is the most common cause of infectious diarrhea in infants and children worldwide — it’s also a leading cause of death among children. Every year, thousands of children are hospitalized with complications of the infection. Your child is likely to have rotavirus at least once before age 5. Children are usually infected when they put their fingers or other objects contaminated with the virus into their mouths.
Adults who are infected with rotavirus usually don’t develop symptoms, but can still spread the illness. Some people, particularly those in institutional settings, may spread the virus even though they don’t have any symptoms of illness themselves.
A vaccine against rotaviral gastroenteritis is available in some countries, including the United States, and appears to be effective in preventing severe symptoms. Talk to your doctor about whether to immunize your child.
• Noroviruses. There are many different strains of noroviruses, including Norwalk virus, that all cause similar symptoms. In addition to diarrhea, nausea and vomiting, you may experience muscle aches, headache, fatigue and low-grade fever.
Both children and adults are affected by noroviruses. Norovirus infection can sweep through families and communities. It’s especially likely to spread among people in confined spaces. In most cases you pick up the virus from contaminated food or water, although person-to-person transmission also is possible.
After exposure to the virus, you’re likely to feel sick within 18 to 72 hours. Most people feel better in a day or two, but you’re still contagious for at least three days — and up to two weeks — after you’ve recovered.
Gastroenteritis occurs all over the world, affecting people of every age, race and background. In developing nations, it’s a leading cause of death in children.
Children in child care centers and older adults living in nursing homes are especially vulnerable. That’s because children’s immune systems aren’t mature until about age 6, and adult immune systems tend to become less efficient later in life.
Intestinal infections can flourish anywhere people congregate — from schools and dormitories to campgrounds and luxury cruise ships. Adults whose resistance is low — often because their immune systems are compromised by HIV, AIDS or other medical conditions — are especially at risk.
Each gastrointestinal virus has a season when it’s most active. If you live in the Northern Hemisphere, you’re more likely to get rotavirus or the Norwalk virus between October and April.
Dehydration — a severe loss of water and essential salts and minerals — is the most common serious complication of gastroenteritis. If you’re a healthy adult and drink enough to replace fluids you lose from vomiting and diarrhea, dehydration shouldn’t be a problem.
But infants, older adults and people with suppressed immune systems may become severely dehydrated when they lose more fluids than they can replace. In that case, they may need to be hospitalized and receive intravenous fluids. In extreme cases dehydration can be fatal.
Tests and diagnosis
Your doctor will likely diagnose gastroenteritis based on symptoms, a physical exam and sometimes on the presence of similar cases in your community. A rapid stool test can detect rotavirus or norovirus, but there are no quick tests for other viruses that cause gastroenteritis. In some cases your doctor may have you submit a stool sample to rule out a possible bacterial or parasitic infection.
Treatments and drugs
There’s often no specific medical treatment for viral gastroenteritis. Antibiotics aren’t effective against viruses, and overusing them can contribute to the development of antibiotic-resistant strains of bacteria. Treatment consists of self-care steps.
To help keep yourself more comfortable and prevent dehydration while you recover, try the following:
• Let your stomach settle. Stop eating and drinking for a few hours.
• Try sucking on ice chips or taking small sips of water. You might also try drinking clear soda, such as 7-UP or Sprite; clear broths; or noncaffeinated sports drinks, such as Gatorade. Affected adults should try to drink plenty of liquid every day, taking small, frequent sips.
• Ease back into eating. Gradually begin to eat bland, easy-to-digest foods such as soda crackers, toast, gelatin, bananas, rice and chicken. Stop eating if your nausea returns.
• Avoid certain foods and substances until you feel better. These include dairy products, caffeine, alcohol, nicotine, and fatty or highly seasoned foods.
• Get plenty of rest. The illness and dehydration may have made you weak and tired.
• Be cautious with medications. Use medications such as ibuprofen (Advil, Motrin, others) sparingly, if at all. They can make your stomach more upset. Use acetaminophen (Tylenol, others) cautiously. It sometimes can cause liver toxicity, especially in children.
When your child has an intestinal infection, the most important goal is to replace lost fluids and salts. These suggestions may help:
• Help your child rehydrate. Give your child an oral rehydration solution such as Pedialyte. Don’t use water — in children with gastroenteritis, water isn’t absorbed well and won’t adequately replace lost electrolytes. You can find oral rehydration solutions in most grocery stores. Talk to your doctor if you have questions about how to use them. Avoid giving your child apple juice for rehydration — it can make diarrhea worse.
• Get back to a normal diet slowly. Gradually introduce bland, easy-to-digest foods, such as toast, rice, bananas and potatoes.
• Avoid certain foods. Don’t give your child dairy products and sugary foods, such as ice cream, sodas and candy. These can make diarrhea worse.
• Make sure your child gets plenty of rest. The illness and dehydration may have made your child weak and tired.
• Don’t give children or teenagers aspirin. It may cause Reye’s syndrome, a rare, but potentially fatal, disease. Avoid giving your child over-the-counter anti-diarrheal medications such as Imodium unless advised by your doctor. They can make it harder for your child’s body to eliminate the virus.
If you have a sick infant, let your baby’s stomach rest for 15 to 20 minutes after vomiting or a bout of diarrhea, then offer small amounts of liquid. If you’re breast-feeding, let your baby nurse. If your baby is bottle-fed, offer a small amount of an oral rehydration solution or regular formula. Don’t dilute your baby’s formula.
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The best way to prevent the spread of intestinal infections is to follow these common-sense precautions:
• Wash your hands thoroughly. And make sure your children do, too. If your children are older, teach them to wash their hands, especially after using the bathroom. It’s best to use warm water and soap and to rub hands vigorously for at least 20 seconds, remembering to wash around cuticles, beneath fingernails and in the creases of the hands. Then rinse thoroughly. Carry towelettes or hand sanitizer for times when soap and water aren’t available.
• Use separate personal items around your home. Avoid sharing eating utensils, glasses and plates. Use separate towels in the bathroom.
• Keep your distance. Avoid close contact with anyone who has the virus, if possible.
• Check out your child care center. Make sure the center has separate rooms for changing diapers and preparing or serving food. The room with the diaper-changing table should have a sink as well as a sanitary way to dispose of diapers.
Take precautions when traveling
When you’re traveling in other countries, you can become sick from contaminated food or water. Follow these tips to help reduce your risk:
• Drink only well-sealed bottled or carbonated water.
• Avoid ice cubes, because ice cubes may be made from contaminated water.
• Use bottled water to brush your teeth.
• Avoid raw food — including peeled fruits, raw vegetables and salads — that has been touched by human hands.
• Avoid undercooked meat and fish.
• Get vaccinated. A vaccine against gastroenteritis caused by the rotavirus is available in some countries, including the United States, and appears to be effective in preventing severe symptoms of this illness.