Differential Diagnosis for Abdominal Pain and Fever in Pediatrics
Single Most Likely Diagnosis
- Viral Gastroenteritis: This is the most common cause of abdominal pain and fever in children, often accompanied by diarrhea and vomiting. The diagnosis is usually clinical, based on symptoms and epidemiological factors.
Other Likely Diagnoses
- Appendicitis: A common surgical emergency in children, presenting with abdominal pain (initially diffuse, then localized to the right lower quadrant), fever, and sometimes nausea and vomiting. Diagnosis is clinical, supported by laboratory tests and imaging.
- Urinary Tract Infection (UTI): Can cause abdominal pain and fever in children, especially if the infection involves the upper urinary tract (pyelonephritis). Diagnosis is made by urinalysis and urine culture.
- Mesenteric Lymphadenitis: Inflammation of the lymph nodes in the mesentery, often mimicking appendicitis, caused by viral or bacterial infections. Diagnosis can be challenging and may require imaging studies.
Do Not Miss Diagnoses
- Intussusception: A condition where a part of the intestine telescopes into another, causing bowel obstruction and potentially ischemia. It's a surgical emergency presenting with abdominal pain, vomiting, and sometimes currant jelly stool. Diagnosis is made by clinical presentation and confirmed by ultrasound.
- Pneumonia: Lower lobe pneumonia can cause referred abdominal pain. Diagnosis is made by clinical examination, chest X-ray, and sometimes blood tests.
- Sepsis: A life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. Early recognition and treatment are crucial. Diagnosis involves clinical assessment, laboratory tests, and imaging.
- Ectopic Pregnancy (in post-pubertal females): Although rare in the pediatric population, it's a critical diagnosis not to miss, presenting with abdominal pain and possibly fever, along with a missed period and positive pregnancy test.
Rare Diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can present with chronic abdominal pain, fever, weight loss, and changes in bowel habits. Diagnosis involves endoscopy, biopsy, and imaging studies.
- Hemolytic Uremic Syndrome (HUS): Typically follows a bacterial infection (like E. coli O157:H7) and can cause abdominal pain, fever, and signs of renal failure and hemolysis. Diagnosis is based on laboratory findings.
- Pancreatitis: Inflammation of the pancreas, which can be acute or chronic, presenting with severe abdominal pain, fever, and elevated pancreatic enzymes. Diagnosis involves laboratory tests and imaging.
- Henoch-Schönlein Purpura (HSP): A form of vasculitis that can cause abdominal pain, fever, rash, and sometimes renal involvement. Diagnosis is clinical, supported by laboratory tests and sometimes biopsy.