Acute viral gastroenteritis

This gastroenteritis is highly contagious. If it is around, hand washing before you eat hopefully will reduce your risk. Everything is suspect - the soap, taps and towel - all can carry these tough little viruses.

I would use one paper towel for the tap and one to dry my hands.

Hot water bottles to relieve tummy cramp, are banned in nursing homes and hospitals, because of the risk of burning someone.
They are great for easing the pain, but one has to be very careful, as you need it quite hot.

Rice water reduces the duration of diarrhoea as well as the volume of stools. Studies in Bangladesh found it to be preferable to glucose based fluids.

"Boil a handful of ground rice in a pot of water and add a pinch of salt" is one recipe. My old hospital used to hand out instructions to boil 2 tablespoons of rice for twenty minutes, strain, make up to 2 pints and add 1/4 teaspoon of salt.

Aside from these practicalities, a lot of things are happening on the immunological front, during an attack of gastro-enteritis.

At one stage it was realized that candida was present in increased numbers, and temporarily was thought to be the cause. This was before rotavirus was discovered.

Immunity in rotavirus infection involves both our cellular and humoral (antibody) immune responses. Candida can affect these responses, and contribute to mucosal damage.

Bowel mucosal lining damage in acute gastroenteritis, allows partly digested and undigested food to enter the tissues more readily, and form immune complexes.

These immune complexes (food plus specific antibody joined together,) are seen in increased amounts in the blood now, and may also contribute to bowel wall (mucosal) damage.

Post infectious  irritable bowel syndrome can follow travellers diarrhoea or ordinary gastroenteritis. This is probably maintained by food intolerance plus leaky gut (mucosal damage from above.)

Intussusception - bowel eating itself

It could be just gastroenteritis, but the infant here has quite severe colicy abdominal pains which come and go (completely.)

If it isn't recognized, blood will eventually seep from their bottom (like redcurrant jelly,) and the infant will become seriously ill.

The intestine has folded in where thickened lining has been caught in the propulsive wave of peristalsis. This leading edge is dragged progressively further down inside the lower bowel.

Early on, the "right iliac fossa" will feel empty of bowel contents when palpated.

This needs urgent correction, using fluid to force the engulfed bowel back into line.

Stomach flu

I use this term when people have aches generally, weakness and fever as well as the d's and v's.

There are many viruses capable of causing this syndrome, not just influenza. This is why influenza vaccines are so little use (see blog archives page.)

If someone close to you has flu, one measure which may protect you is short term vitamin C megadose, up to bowel tolerance. This dose varies greatly between individuals, but is usually grams per day rather than milligrams. It is almost enough to actually cause diarrhoea (here odorless.)

Travellers diarrhea

Imagine an attack of explosive diarrhea on a tour bus - I use a preventative.

One of my patients was a teacher on a school trip to China, took Ultra probioplex, and was the only one of the entire party not to succumb.

It's good stuff! (made from bovine colostrum)

In a Swiss study only 2% of the travellers who responded had exactly followed the strict hygiene advice given at the start of the study, even in the first 3 days of their trip!

Easier to be reasonably careful plus take a colostrum preparation.

Also, Dukoral cholera vaccine apparently provides about 50% protection against ETECtravellers' diarrhoea for 3 months. I've no experience of this off label use.

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Peristalsis is muscular contraction of the bowel wall which squeezes the contents and propels them down the gut, as seen when a snake swallow something large.

The right iliac fossa is basically the lower right sided quarter of the abdomen, named as the iliac bone of the pelvis forms it's back wall. Palpation is prodding to check for tenderness or lumps usually, but in this case for the absence of what should be there.

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