Differential Diagnosis for Abdominal Pain in a 5-year-old Female
- Single most likely diagnosis:
- Constipation: The patient's history of constipation and the mother's uncertainty about the last bowel movement, combined with the transient nature of the abdominal pain, make constipation the most likely diagnosis. The fact that the patient is afebrile and active, with no nausea or vomiting, further supports this diagnosis.
- Other Likely diagnoses:
- Functional abdominal pain: This is a common condition in children, characterized by recurrent abdominal pain without an identifiable cause. The patient's age and the absence of alarming symptoms make this a plausible diagnosis.
- Gastroenteritis: Although the patient denies nausea and vomiting, gastroenteritis can sometimes present with abdominal pain alone. The fact that the pain occurred at night and resolved by morning could be consistent with a viral gastroenteritis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Appendicitis: Although the patient's symptoms have resolved, appendicitis can present with intermittent pain, and it is crucial to consider this diagnosis in any child with abdominal pain. The fact that the patient is afebrile and active does not rule out appendicitis.
- Intussusception: This is a condition where a portion of the intestine telescopes into another, causing abdominal pain and potentially leading to bowel ischemia. Although the patient's symptoms have resolved, intussusception can present with intermittent pain, and it is essential to consider this diagnosis.
- Volvulus: A volvulus is a twisting of a portion of the intestine, which can cause abdominal pain, nausea, and vomiting. Although the patient denies these symptoms, a volvulus can be a life-threatening condition if not promptly diagnosed and treated.
- Rare diagnoses:
- Inflammatory bowel disease (IBD): Although IBD is less common in children, it can present with abdominal pain, and it is essential to consider this diagnosis, especially if the patient has a family history of IBD.
- Abdominal migraine: This is a rare condition characterized by recurrent episodes of abdominal pain, often accompanied by other symptoms such as headache or nausea. Although the patient denies these symptoms, abdominal migraine is a possible diagnosis to consider.