Can you make the diagnosis?

Shelly is very excited to be on her first cruise.  She has been enjoying the sun, food and drink on the ship as she heads to the Caribbean.

On the third day of her cruise, she feels a bit under the weather, and doesn’t want to eat breakfast.  Then her stomach becomes unsettled, and she feels nauseated.  Next she begins to have diarrhea, but the worst is still to come.  She begins vomiting repeatedly, and spends the night on the floor of her cabin bathroom.

What caused Shelly’s illness?

  1.  Appendicitis
  2. Gallstones
  3. Too much alcohol
  4. Norovirus


If you chose 4. Norovirus, you are right!

Norovirus is also called “the winter vomiting bug”, or “the stomach flu”.  We often hear about it sweeping through schools, nursing homes, and cruise ships.

Norovirus causes vomiting, diarrhea, and stomach pain.  Fever and headache can occur.

How do you get Norovirus?  It is transmitted by “fecal-oral” route, which basically means a person who has the infection touches food or other objects without adequate hand-washing after going to the bathroom.  Then another person consumes the food, or touches an object and then touches their mouth, contracting the virus.

Norovirus symptoms usually last 1-3 days.

While most people with Norovirus recover on their own, complications can occur such as severe dehydration.

Patients with Norovirus should try to take smalls sips of fluid, rest, and frequently wash their hands.

There are 685 million cases of Norovirus a year, and 200,000 deaths worldwide from the virus.  In 2018, there were 11 cruise ships that had Norovirus outbreaks.

The infection is named after Norwalk, Ohio, which had a very large outbreak in 1968.

Appendicitis usually starts with vomiting, and patients develop pain that moves to the right lower portion of the abdomen.  Gallstones cause pain in the right upper portion of the abdomen.  Both appendicitis and gallstones often cause vomiting, but diarrhea would be an uncommon symptom.  Alcohol can cause vomiting, but would be unusual to cause such significant diarrhea.


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