Differential Diagnosis for a 5-year-old with Abdominal Pain, Emesis, Diarrhea, and Decreased Appetite
- Single most likely diagnosis:
- Urinary Tract Infection (UTI) - The patient's symptoms of abdominal pain, emesis, and diarrhea, along with a history of previous UTIs and a positive urine dip for moderate leukocytes, suggest a UTI. The mother's observation that the symptoms are consistent with previous UTIs further supports this diagnosis.
- Other Likely diagnoses:
- Gastroenteritis - The presence of emesis, diarrhea, and abdominal pain could indicate a viral or bacterial gastroenteritis. The fact that she is tolerating oral liquids and has soft stools also points towards this diagnosis.
- Viral gastroenteritis - Similar to gastroenteritis, the symptoms of vomiting, diarrhea, and decreased appetite are common in viral gastroenteritis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Appendicitis - Although less likely given the patient's age and symptoms, appendicitis can present with abdominal pain, vomiting, and diarrhea. It is crucial to consider this diagnosis due to its potential severity and need for prompt surgical intervention.
- Intussusception - A condition where a part of the intestine slides into an adjacent part, which can cause abdominal pain, vomiting, and diarrhea. It is a medical emergency that requires immediate attention.
- Pyelonephritis - An infection of the kidney, which can present with symptoms similar to a UTI but may also include flank pain and fever. Given the patient's history of UTIs, this is a potential diagnosis that should not be missed.
- Rare diagnoses:
- Inflammatory bowel disease (IBD) - Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain, diarrhea, and weight loss. Although rare in children, it should be considered if symptoms persist or worsen over time.
- Henoch-Schönlein purpura (HSP) - A condition that can cause abdominal pain, vomiting, and diarrhea, along with a characteristic rash. It is relatively rare but should be considered in the differential diagnosis due to its potential for complications.