Differential Diagnosis for a 5-year-old Girl with Abdominal Cramping and Diarrhea
- Single most likely diagnosis:
- Viral Gastroenteritis: This is the most likely diagnosis given the patient's symptoms of abdominal cramping, diarrhea that started as watery and progressed to contain visible mucus, and the presence of similar cases among other children at her day care. The fever and diffuse abdominal tenderness also support this diagnosis.
- Other Likely diagnoses:
- Bacterial Gastroenteritis: The presence of occult blood in the stool and the progression of diarrhea could suggest a bacterial cause, such as Salmonella, Shigella, or Campylobacter. The fact that several other children at the day care have similar symptoms could indicate a contagious bacterial agent.
- Rotavirus Infection: Although vaccination has decreased its incidence, rotavirus can still cause severe gastroenteritis in children, characterized by watery diarrhea, vomiting, and fever.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Intussusception: Although less common, intussusception is a life-threatening condition that can cause abdominal pain, diarrhea (sometimes with blood and mucus), and fever. It requires prompt diagnosis and treatment.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can present with chronic diarrhea, abdominal pain, and sometimes blood in the stool. Early diagnosis is crucial for managing these conditions.
- Hemolytic Uremic Syndrome (HUS): This condition, often associated with E. coli infections, can lead to severe kidney failure and is characterized by diarrhea, hemolytic anemia, and acute kidney injury.
- Rare diagnoses:
- Giardiasis: An intestinal infection caused by the Giardia parasite, which can lead to chronic diarrhea, abdominal cramps, and weight loss.
- Food Poisoning: Certain types of food poisoning (e.g., from Staphylococcus aureus or Bacillus cereus) can cause acute onset of vomiting and diarrhea, but the presence of fever and abdominal tenderness might be less common.
- Parasitic Infections: Other parasitic infections like cryptosporidiosis or amoebiasis are less common but can cause similar symptoms, especially in immunocompromised individuals or those exposed to contaminated water.