Differential Diagnosis for Bilious Diarrhea in a 12-Month-Old
Single Most Likely Diagnosis
- Viral Gastroenteritis: This is the most common cause of bilious diarrhea in infants, often resulting from rotavirus, norovirus, or adenovirus infections. The presence of bilious vomiting suggests an intestinal obstruction or ileus, but in the context of diarrhea, viral gastroenteritis is a leading consideration due to its high prevalence.
Other Likely Diagnoses
- Bacterial Gastroenteritis: Bacteria like Salmonella, Shigella, or Campylobacter can cause bilious diarrhea. These infections are less common than viral but still significant, especially if the child has been exposed to contaminated food or water.
- Food Intolerance or Allergy: Conditions such as lactose intolerance or an allergy to cow's milk proteins can lead to gastrointestinal symptoms, including diarrhea. However, bilious diarrhea is less typical and would prompt investigation into other causes.
- Toddler's Diarrhea: A condition characterized by chronic, non-bilious diarrhea in toddlers, but it can occasionally present with bilious stools if there's an associated gastrointestinal infection.
Do Not Miss Diagnoses
- Intussusception: A condition where a part of the intestine telescopes into another, leading to obstruction and potentially bilious vomiting and diarrhea. It's a surgical emergency and must be considered, especially if there's abdominal pain or currant jelly stool.
- Volvolus or Midgut Volvulus: These are intestinal obstructions that can cause bilious vomiting and diarrhea. They are emergencies requiring immediate surgical intervention.
- Hirschsprung's Disease: A congenital condition affecting the colon, leading to severe constipation or obstipation, but in some cases, it can present with diarrhea due to enterocolitis. It's crucial to diagnose to prevent complications.
Rare Diagnoses
- Congenital Chloridorrhea: A rare genetic disorder leading to excessive chloride loss in the stool, resulting in chronic diarrhea.
- Microvillous Inclusion Disease: A rare congenital disorder affecting the small intestine, leading to severe, watery diarrhea from birth.
- Tufting Enteropathy: A rare condition characterized by chronic diarrhea starting in infancy, with a distinct histological appearance of the intestinal mucosa.
Each of these diagnoses has a different approach to management and treatment, emphasizing the importance of a thorough diagnostic evaluation to guide appropriate care.