Gastroenteritis: Symptoms, Causes, and Treatment Options

Gastroenteritis? Norovirus?

On March 13, the whole family happily went out for a meal at an izakaya, where they consumed raw seafood, including oysters, salmon, tuna, shrimp, and salmon roe.
On the evening of March 14, at 9 PM, the son began to feel gastrointestinal discomfort and started vomiting, followed by the daughter who also vomited.
On March 15, they went to see a doctor, who diagnosed them with gastroenteritis (the husband also vomited that day, while the mother only felt nauseous without vomiting).
After taking medication for three days, everyone thought they had recovered, but unexpectedly, on the evening of March 16, the son started experiencing diarrhea and was taken to see a doctor.
Just after the son finished his appointment, the mother began to experience abdominal pain, and later that night, the daughter started having diarrhea.
On March 17, both the mother and daughter went for a consultation, and the doctor stated that the gastroenteritis had not yet resolved, prescribing the same medication, which improved the daughter's condition.
However, the mother experienced severe abdominal pain that night and went to the internal medicine department, where medication provided slight relief.
The next day, March 18, after eating congee, the pain returned, prompting another visit to a gastroenterologist, who diagnosed norovirus.
The medication significantly improved her condition, but she still occasionally experienced pain.
This pain was described as cramping around the navel and in the left abdomen.
However, she struggled to have a bowel movement, managing only a small amount or a tiny stool.
After taking medication, on March 23, they visited a large hospital, informing the doctor that despite taking many medications, they still could not return to normal gastrointestinal function.
The doctor advised observation and prescribed pain relievers and laxatives.
So far, the cycle continues: experiencing pain, attempting to have a bowel movement, but only managing to pass a little or nothing at all.

Xie le qi de pi qiu, 30~39 year old female. Ask Date: 2021/03/24

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, it is possible that your gastroenteritis has not fully recovered.
Norovirus is highly contagious and can be contracted by consuming contaminated food or water (such as oysters, clams, and salad).
Symptoms include vomiting, abdominal cramps, and diarrhea.
During gastroenteritis, symptom management is important; initially, pay attention to dehydration and replenish fluids and electrolytes.
A bland diet (avoid greasy and sweet foods) with small, frequent meals is recommended to prevent irritation of the gastrointestinal tract.
Also, ensure adequate nutrition to aid in the repair of the gastrointestinal mucosa.
Maintain personal and environmental hygiene to avoid transmission.
The duration of gastrointestinal symptoms during gastroenteritis varies from person to person.
If there are no diarrhea medications available, adjustments can be made, and follow-up in the outpatient clinic is advised.
Wishing you safety and health.
Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2021/03/24

More Info

Gastroenteritis, commonly referred to as stomach flu, is an inflammation of the stomach and intestines that can lead to a variety of symptoms, including nausea, vomiting, diarrhea, abdominal pain, and fever. It is often caused by viral infections, such as norovirus or rotavirus, but can also be triggered by bacterial infections, food poisoning, or parasites. In your case, it seems that your family experienced a classic outbreak of gastroenteritis after consuming raw seafood, which is a known risk factor for such infections.

The timeline you provided indicates that the symptoms began shortly after the meal, which aligns with the typical incubation period for foodborne illnesses. The rapid onset of vomiting and diarrhea in multiple family members suggests a contagious agent, likely viral, especially since norovirus is notorious for spreading in close quarters and can affect multiple people simultaneously.

Symptoms and Progression
Initially, your family experienced nausea and vomiting, which are common early symptoms of gastroenteritis. As the illness progressed, diarrhea became a prominent symptom, particularly in your son. The abdominal pain you described, especially around the navel and left abdomen, is also typical of gastroenteritis, as the inflammation can lead to cramping and discomfort.

The fact that your symptoms persisted despite treatment is concerning. Gastroenteritis can sometimes lead to complications such as dehydration, especially in children and the elderly, which may require medical intervention. The ongoing abdominal pain and difficulty with bowel movements suggest that your gastrointestinal tract may still be irritated or that there could be a secondary issue, such as a post-infectious irritable bowel syndrome (IBS) or even a mild obstruction.

Treatment Options
1. Hydration: The most critical aspect of managing gastroenteritis is maintaining hydration. Oral rehydration solutions (ORS) are recommended to replenish lost fluids and electrolytes. If symptoms are severe, intravenous fluids may be necessary.

2. Diet: A bland diet is often recommended during recovery. Foods like bananas, rice, applesauce, and toast (the BRAT diet) can help settle the stomach. Avoiding dairy, fatty foods, and high-fiber foods initially can also be beneficial.

3. Medications: Over-the-counter medications like loperamide (Imodium) can help reduce diarrhea, but they should be used cautiously, especially if there is a high fever or blood in the stool, as these could indicate a bacterial infection that requires different treatment. Pain relievers such as acetaminophen can help manage fever and discomfort.

4. Monitoring Symptoms: It’s essential to keep track of symptoms. If diarrhea persists for more than a couple of days, or if there are signs of dehydration (such as dry mouth, decreased urination, or dizziness), it’s crucial to seek medical attention.

5. Follow-Up Care: Given that your symptoms have not fully resolved, follow-up with a healthcare provider is essential. They may consider additional tests, such as stool cultures or imaging studies, to rule out other conditions or complications.

Conclusion
In summary, gastroenteritis can be a self-limiting condition, but it requires careful management to prevent complications. Your family’s experience highlights the importance of prompt medical attention and the need for ongoing monitoring of symptoms. If abdominal pain persists or worsens, or if new symptoms arise, further evaluation by a gastroenterologist may be warranted to ensure that there are no underlying issues that need to be addressed. Remember, while gastroenteritis is often viral and resolves on its own, persistent symptoms should always be taken seriously to rule out more severe conditions.

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