Differential Diagnosis for 8-year-old with Abdominal Discomfort
- Single most likely diagnosis:
- Constipation with encopresis: The patient has a significant past medical history of constipation, which required hospital admission for an inpatient cleanout. The presentation of abdominal discomfort, decreased appetite, and liquid stool accidents (encopresis) is consistent with constipation, especially given the history of picky eating and inadequate fluid intake.
- Other Likely diagnoses:
- Gastroenteritis: Although the mother denies nausea, vomiting, or diarrhea, the patient did have liquid stool accidents, which could be a sign of a gastrointestinal infection.
- Functional abdominal pain: The patient's abdominal discomfort and decreased appetite could be related to functional abdominal pain, which is a common condition in children.
- Dehydration: The patient's limited fluid intake and decreased appetite may lead to dehydration, which can exacerbate abdominal discomfort.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Intussusception: Although less likely, intussusception is a serious condition that requires prompt diagnosis and treatment. The patient's abdominal discomfort and liquid stool accidents could be signs of intussusception.
- Appendicitis: Appendicitis is a surgical emergency that requires prompt diagnosis and treatment. Although the patient's symptoms are not typical for appendicitis, it is essential to consider this diagnosis in any child with abdominal pain.
- Inflammatory bowel disease (IBD): IBD, such as Crohn's disease or ulcerative colitis, can present with abdominal pain, decreased appetite, and changes in bowel habits.
- Rare diagnoses:
- Hirschsprung's disease: This congenital condition affects the colon and can cause severe constipation, abdominal discomfort, and enterocolitis.
- Neurogenic bowel: This condition can cause constipation, fecal incontinence, and abdominal pain due to nerve damage affecting the bowel.