Many of us get gastrointestinal tract infections each year. Gastro-intestinal tract diseases present with vomiting and loose motion. It is almost the hallmark characteristic sign of any gastrointestinal disorder. You may get abdominal pain, blood in loose motions and fever, jaundice with these symptoms. If severity is enough this condition may cause you to suffer from dehydration and in children may cause death too. Most common causes of vomiting and loose motion are gastroenteritis and hepatitis.
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What is the cause of vomiting and loose motion?
Vomiting and loose motions can be a symptom of multiple intestinal diseases. These are usually common diseases in parts of the world where clean drinking water is not available. The causes range from infections to food poisonings and sometimes more serious causes like cancer.
These symptoms of vomiting and loose motions occur because of following reasons:
E. coli infection
Hepatitis A and E
Acute cases of Hepatitis B
Also includes some other viruses and parasitic causes
Above table contains the list of causes of vomiting and loose motion. Now we will discuss some important and common causes in detail.
Cholera is an infectious disease caused by the bacteria Vibrio cholerae. It has caused cholera pandemics multiple times in the past. Now it is endemic to regions where sanitation facilities are lacking and no clean drinking water is available. It is a reportable disease and cases are still reported from the developing countries. It spreads through contaminated water and food and gets excreted in the excreta of the infected person. This disease causes vomiting and loose motions. Loose motions are characteristically rice water like consistency and high volume. Large volume and multiple episodes of loose motions cause quick dehydration and particularly in children below 5 years causes death. Along with loose motions there are multiple episodes of vomiting. If not treated with adequate hydrating fluids it can quickly cause deaths.
Typhoid is caused by Salmonella typhi and paratyphi. It is again a disease that spreads through contaminated water and food. This disease is also called enteric fever. Generally fever with constipation and abdominal pain are the symptoms but some patients may show vomiting and loose motions in this disease too. It mainly occurs in developing parts of the world. Recently it is a matter of concern as antibiotics are the only treatment and Salmonella typhi resistant to multiple antibiotics are found nowadays commonly.
Escherichia coli is again the infection spread by contaminated water and food. It presents like nausea, vomiting and loose motions. Mainly entero toxigenic strain and enteropathogenic strain cause vomiting and loose motion. The toxins produced by this bacteria behave similarly to those of toxins of V. cholerae. These bacterial infections too can cause large volume and multiple loose motion causing dehydration very quickly.
Dengue disease is caused by the infection of dengue virus. This disease is spread by the mosquitoes of the Aedes aegypti species. This is not only a disease of only the intestine but also causes systemic infection. It presents with high grade fever with vomiting and loose motions. In this disease blood pressure of the patient may fall and the patient may go into shock. In Addition to that vomiting and loose motions can quickly cause dehydration. Every year in monsoon season the dengue epidemic engulfs South East Asia and other parts of the world.
In areas with poor sanitary facilities and lack of clean drinking water, multiple viral infections may cause gastroenteritis. In this disease there is vomiting and loose motions along with other symptoms like fever and dehydration. Amongst all the viral causes of vomiting and loose motions Rotavirus is the most common cause. It mainly attacks children below the age of 5 years. With the frequency of loose motions and vomiting children can quickly go into a state of dehydration. If the severe cases are not managed properly it may cause dehydration and death. Other causes of this condition are Norovirus, adenovirus.
Malaria is a febrile disease caused by parasites that are spread by female mosquitoes of anopheles type. This condition is most commonly caused by Plasmodium falciparum and Plasmodium vivax. Other parasites causing malaria are less common and they are Plasmodium malarae and Plasmodium ovale and Plasmodium knowlesi. In this disease patients have fever with chills. Patients suffer from vomiting and also in some patients vomiting and loose motions occur. Complications of this disease may cause death. The treatment of this disease is antimalarial drugs. Recently more and more malaria causing parasites are found to be resistant to antimalarial drugs is a matter of concern. Malaria is one of the most common infectious diseases in the world getting reported.
Hepatitis is inflammation of the liver. This condition can be caused because of infectious or non infectious causes. In this disease there may be jaundice, vomiting and loose motions. Amongst all causes of hepatitis, viral infections are more common. Hepatitis A and Hepatitis are commonest types of hepatitis. These infections are caused by drinking contaminated water and eating contaminated food. In some patients infections are severe and can cause liver failure and death. Hepatitis B is spread by blood, needles and sex. Hepatitis B in acute stages in adolescents and adults presents like severe hepatitis. In adolescents and adults 10 percent of total cases go into phase of chronic hepatitis disease. Younger the age at the time of infection more are the chances of patients going into chronic hepatitis after acute hepatitis.
Giardiasis is a parasitic infection of the intestinal tract and causes profuse loose motions with vomiting in some patients. It is caused by the parasite Giardia lamblia. It may cause chronic infection lasting for weeks in some patients. In this disease the ability of the affected person to digest the food is reduced and the person, particularly the children, may experience weight loss and growth failure.
Food poisoning is caused by eating stale food. The food causing food poisoning may look edible but harbours the agents causing food poisoning. After some time at room temperature bacterias grow in food and they produce toxins that affect your intestinal tract when you consume that food. Staphylococcus, Bacillus cereus, E. coli, Cholera, viruses and some parasites are the cause of the food poisoning. The symptoms of vomiting and loose motions occur because of toxins or the infection of the intestinal tract. Along with these symptoms patients may suffer from fever, blood in stools and abdominal pain.
Accidental or intentional intake of toxins may cause symptoms of vomiting and loose motion. Particularly arsenic poisoning causes abdominal pain, vomiting and loose motion, blood in stool. High index of suspicion is needed to come to diagnosis as it may mimic other common infectious causes.
Food intolerance is caused by inability to digest the components of the food. This inability may cause vomiting and loose motions after consuming particular food. Some examples of this condition are lactose intolerance and fructose intolerance. Lactose intolerance symptoms are seen after drinking lactose containing foods like milk. Fructose intolerance is seen after consuming fructose sugar containing foods like fruits.
Inflammatory diseases are conditions causing inflammation in the body. The inflammatory diseases involving your intestine or liver may cause the symptoms of vomiting and loose motions. These diseases are rare compared to infectious diseases and patients generally have chronic symptoms lasting for weeks to months leading to weight loss or growth failure.
What tests are needed for vomiting and loose motion?
If there are no associated symptoms and your doctor suspects that you just have gastroenteritis without dehydration, you may not need to do any tests. Tests are required if there is dehydration or other causes like malaria, dengue, hepatitis.
Following test may be needed:
- HBCBC: This is a non-specific test, but it gives a fair idea about anaemia and WBC and platelet counts. This test gives hemoglobin count, number of WBC and platelets. It also gives ideas about RBC indices. In diseases like malaria, dengue platelet count may be decreased. In dengue cases even WBC count is decreased and haematocrit is found to be increased. Any other infections WBC count may increase.
- RFT with serum electrolytes: Because of vomiting and loose motion causing dehydration, may increase blood urea levels and blood creatinine levels. In these diseases serum electrolytes like serum sodium and serum potassium level may alter. These all levels are detected by renal function test. This needs to be identified and as management is needed to normalise these indices.
- If vomiting and loose motion is suspected to be because of dengue disease, for the diagnosis NS1 antigen level, serum anti dengue IgG, IgM levels may be needed to examine.
- If malaria is suspected peripheral blood smear to detect malaria parasite and malaria antigen test may be needed.
- If you have pain in the abdomen on the right upper side, and jaundice, your doctor may suggest you have a liver function test. This test detects serum bilirubin and liver enzyme levels. They may be increased in hepatitis cases.
- Ultrasonography abdomen: This tastes detect hepatomegaly in case of hepatitis. This test also detects inflammation of the intestine. It can detect other causes of vomiting and loose motion like intestinal obstruction. It also detects the inflammation of the urinary bladder as it may occur in urinary tract infection.
- CRP and ESR: These markers to detect the presence of inflammation. Their level is increased in various inflammatory diseases including the inflammatory diseases of the intestine.
- Stool examination: Stool examination can detect causes like cholera and parasites infection of intestine. It also detects the presence of food intolerance.
As we discussed earlier this many tests may not be required for each patient. History and clinical examination of the patient suggest the further workup needed for the patient.
What are complications of vomiting and loose motion?
As we have discussed earlier, vomiting and loose motion is caused by multiple causes. These all diseases have complications of their own. Here we will discuss only the complications that are caused by above said symptoms that are vomiting and loose motions.
- Dehydration: This is the most common complication that occurs because of loss of excess water from the body. The symptoms are dryness of mouth and skin and other mucosal areas, sunken eyes. In children in whom anterior fontanelle is open can appear sunken anterior fontanelle. The person with dehydration may feel thirsty. The urine output is reduced. In severe cases lethargy, loss of consciousness and fall of blood pressure and death may occur.
- Electrolyte imbalance: This condition occurs because of loss of excess water or electrolytes from the body. It may present like hyponatremia and hypernatremia or hyper or hypokalemia. If not treated it may cause death.
- Shock: It is a condition in which excess fluid loss may lead to fall in blood pressure. It occurs more frequently in children.
- Death: Vomiting and loose motion occur because of multiple reasons like, dehydration, electrolyte imbalance, kidney failure.
- Kidney failure: Severe dehydration because of vomiting and loose motion causes kidney failure.
What is the treatment of vomiting and loose motion?
Vomiting and loose motion are symptoms. They are caused by many diseases. The underlying disease may need specific treatment for that disease. We will see the treatment of vomiting and loose motions.
Antiemetics are drugs that are given to patients to stop vomiting. Once the vomiting is stopped the patient can tolerate oral hydration therapy and the dehydration can be taken care of. Ondansetron and domperidone are drugs that can be given orally in form of syrups or tablets. Ondansetron can be given by injection. The doses needed depend on your weight and age.
Oral rehydration solutions help to treat dehydration. The quantity of ORS needed depends upon age, weight, and severity of dehydration.
Oral fluids like drinking water, rice water, coconut water, tomato soupe, chicken soup are acceptable but not as good as ORS.
If a patient is not able to take ORS and fluids orally, the dehydration is to be treated with IV fluids. Intravenous fluids are given in the form of normal saline 0.9 percent or lactated ringer solution. The amount of intravenous fluids depends upon the weight of the patient and rate of ongoing dehydration.
If the vomiting and loose motion is because of malaria, it needs treatment of malaria with antimalarial drugs. Chloroquine, primaquine, and artemisinin are some antimalarials.
Most of the time vomiting and loose motions are because of viral causes or non- infectious causes. In these cases antibiotics have no role. Even in cases of bacterial infections causing gastroenteritis antibiotics have limited roles and sometimes use of antibiotics may lead to complications like HUS. So antibiotics should be used judiciously. Cholera and typhoid need treatment with antibiotics along with supportive therapy.
Antidiarrheal drugs stop loose motions by slowing the movement of intestines. They are suggested only in non-infectious cases. For infectious cases antidiarrheal drugs are to be avoided as they may cause life threatening complications in these cases.
How to prevent these conditions?
We have discussed the causes of vomiting and loose motions. Most of the causes are infectious and can be prevented.
Following are the strategies of prevention:
- Use clean water for drinking. Boil the drinking water for 10 minutes and then use it for drinking after cooling. Chlorine drops can be used in an appropriate dose, these drops are effective at killing germs causing infections.
- Eat food only prepared at hygienic places.
- Avoid stale food. Store your food with almost care to avoid food poisonings.
- Wash your hands with soap water before food and after using toilets.
- Wash vegetables and fruits before consuming them.
- Prefer freshly and hygienically prepared food.
- Only breastfeeding till 6 months of age.
- Vaccinate your infants and children with rota virus vaccine and typhoid, cholera vaccines.
- If you are going to visit endemic areas get vaccinated for typhoid, cholera, Hepatitis A.
- Clean drinking water and adequate sanitary facility should be available to all.
- Waste water should be treated in sewage treatment plant before it goes to rivers.
- Use latrine for defecation. Avoid open defecation.