Clinical Pathways
Clinical Pathways
Gastroenteritis in Pediatrics - Urgent Care
Gastroenteritis in Pediatrics - Urgent Care

Gastroenteritis in Pediatrics - Urgent Care

Tags
EB Urgent Care
Published
April 15, 2022
Author(s)
Emily Montgomery, MD, MPHE, FAAP KeriAnne Brady, MD, FAAP

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Action

Patient with suspected acute gastroenteritis (diarrhea with or without vomiting and abdominal pain) presents to the UC with dehydration

Decision

Is the patient hemodynamically stable?

Background

Physical Examination

As always, the physical examination should begin with a review of the vital signs. Look for fever, tachycardia, and hypotension. Hypotension is usually a late finding in dehydration or may indicate a more severe etiology of the patient’s symptoms. Tachypnea may be a sign of respiratory compensation for metabolic acidosis secondary to dehydration and starvation ketoacidosis. Capillary refill should be evaluated, as children often manifest delayed capillary refill (>2 seconds) before hypotension. Children with minimal dehydration (<3% loss of body weight) will have a normal physical examination. Children with mild-to-moderate dehydration (3%-9% loss of body weight) may have slightly sunken eyes, decreased tears, dry mouth, and slightly increased heart rate. Children with severe dehydration (>9% loss of body weight) will likely be lethargic and tachycardic, with no tears, very dry mouth, and prolonged capillary refill.

The abdominal examination should locate any tenderness to palpation, making note if there is no tenderness, diffuse tenderness, or focal tenderness (eg, epigastric, right upper quadrant, or right lower quadrant). AGE tends to cause mild and diffuse abdominal pain; however, sometimes it causes no pain at all. Patients with focal tenderness should be considered to have another diagnosis, such as pancreatitis with epigastric/periumbilical tenderness, cholecystitis or hepatitis with right upper-quadrant tenderness, or appendicitis with right lower-quadrant tenderness.

Skin and eye examinations are also important. Jaundice is not expected in AGE and should raise suspicion for liver, pancreas, or gallbladder disease. A genitourinary examination should be performed in all patients with abdominal pain to evaluate for a testicular/ovarian pathology. Consider a pelvic examination in all sexually active females to evaluate for gynecological mimics of AGE.

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References

Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study is included in bold type following the references, where available. The most informative references cited in this paper, as determined by the author, are noted by an asterisk (*) next to the number of the reference.

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