Differential Diagnosis for Epigastric Abdominal Pain in an 8-Year-Old
Single Most Likely Diagnosis
- Viral Gastroenteritis: This is the most common cause of abdominal pain in children, often accompanied by nausea, vomiting, and diarrhea. The epigastric location of the pain could be due to the involvement of the stomach.
Other Likely Diagnoses
- Functional Dyspepsia: A common condition in children characterized by recurrent abdominal pain, often in the epigastric region, not explained by other medical conditions. It can be related to eating or stress.
- Gastroesophageal Reflux Disease (GERD): Can cause epigastric pain due to the reflux of stomach acid into the esophagus, especially after eating or at night.
- Constipation: Although more commonly associated with lower abdominal pain, constipation can sometimes cause upper abdominal discomfort, including the epigastric area, especially if the constipation is severe.
Do Not Miss Diagnoses
- Appendicitis: Although appendicitis typically presents with pain in the lower right abdomen, it can start as epigastric pain that then migrates. Missing appendicitis can lead to serious complications, including perforation and peritonitis.
- Pyloric Stenosis: More common in infants but can occur in older children, causing severe vomiting and epigastric pain due to obstruction of the gastric outlet.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause severe abdominal pain, including epigastric pain, and is a medical emergency.
- Pancreatitis: Though rare in children, pancreatitis can cause severe epigastric pain and requires prompt medical attention.
Rare Diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic abdominal pain, including in the epigastric region, though they are less common in young children.
- Peptic Ulcer Disease: Can cause epigastric pain, especially related to eating, but is less common in children without a specific risk factor like NSAID use or Helicobacter pylori infection.
- Hepatic or Biliary Disease: Conditions affecting the liver or bile ducts, such as hepatitis or choledochal cysts, can cause upper abdominal pain but are relatively rare in children.