Clinical Presentation
Toxin-Induced Food Poisoning
Toxin-induced food poisoning should be suspected in those with vomiting as the major presenting symptom.
Bacterial Toxin-Induced Food Poisoning
The incubation period of bacterial toxin-induced food poisoning varies depending on the causative agent. Diarrhea may follow vomiting and is usually not so severe. Abdominal pain may also be present and is usually colicky in nature. Most patients are afebrile and not severely dehydrated unless vomiting or diarrhea is intense.
Traveler’s Diarrhea
Gastroenteritis - Bacterial_Initial Assesment 1Traveler’s diarrhea is usually considered in a person who normally resides in an industrialized region and who travels to developing or underdeveloped countries. This may also refer to illness that occurs within 7-10 days after returning home. Patients often feel weak and have orthostatic symptoms.
Watery Diarrhea
Watery diarrhea is semi-formed to loose-watery stools without the presence of blood. This is often a clinical presentation of enterotoxin-induced diarrhea.
Gastroenteritis - Bacterial_Initial Assesment 2Cholera is highly suggested by severe profuse watery diarrhea and dehydration. Other clinical features include a very abrupt onset of acute diarrhea with rapid progression to severe dehydration and the presence of muscle cramps, but no fever or abdominal pain is noted. Stools are usually greenish-yellow, clear, and watery with little food residue. Dark-field microscopy (DFM) and stool culture may be done when available. A microscopic exam of stool may also reveal shooting bacteria, but not white blood cells (WBC) or red blood cells (RBC). If cholera is confirmed in non-endemic areas, it should be reported to health authorities. Any case of watery diarrhea in endemic areas during outbreaks or seasonal epidemics should be treated as cholera, and stool cultures should be done in all cases to confirm.
Bloody Diarrhea
Bloody diarrhea is considered if the macroscopic exam of stools contains blood. Patients often have fever that may last >2 days and may be high (>38.5°C). Patients may initially suffer with watery diarrhea that rapidly changes to bloody diarrhea and dysentery. There is mild dehydration. White blood cells (WBC) and red blood cells (RBC) are found in the microscopic exam of the stools. Dysentery is suggested by frequent passage (10-30 times per day) of small-volume stools that consist of blood, mucus, and pus. Patient usually suffers abdominal cramps and tenesmus.
History
Symptoms
Determine if symptoms are abrupt or gradual in onset, the duration and progression of symptoms, the onset and frequency of bowel movement, and the amount of stool excreted. Note also if dysenteric symptoms are present (eg fever, tenesmus, blood, or pus in stool).
Associated Symptoms
Associated symptoms include frequency and intensity of nausea or vomiting, abdominal pain, cramps, myalgia, headache, and altered sensorium.
Symptoms of Volume Depletion
Symptoms of volume depletion include thirst, tachycardia, orthostasis, decreased urination, decrease in skin turgor, and lethargy.
Physical Examination
Gastroenteritis - Bacterial_Initial Assesment 3Vital signs would show orthostatic pulse, blood pressure changes, changes in the rate of breathing, or the presence of fever. Other signs of volume depletion include dry mucous membranes and decreased skin turgor. Abdominal tenderness or altered sensorium may be present. Accurate body weight should be measured to estimate fluid loss. Other findings may include excessive irritability, cyanosis, and petechial rash.