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Differential Diagnosis for 12-year-old Patient with Abdominal Symptoms and Psychological Factors

Single Most Likely Diagnosis

  • Functional Abdominal Pain: This diagnosis is likely due to the patient's report of diffuse epigastric pain, nausea, vomiting, diarrhea, and headache, which have been ongoing for 2 weeks. The symptoms are non-specific and could be related to stress or anxiety, especially given the patient's history of being bullied at school and not liking to attend school. The fact that the antidepressant is helping suggests that there may be an underlying psychological component to the patient's symptoms.

Other Likely Diagnoses

  • Irritable Bowel Syndrome (IBS): The patient's symptoms of abdominal pain, nausea, vomiting, and diarrhea could be consistent with IBS, especially if the symptoms are relieved by bowel movements or are associated with changes in bowel habits.
  • Gastroesophageal Reflux Disease (GERD): The patient's report of epigastric pain could be related to GERD, especially if the pain is worsened by eating or lying down.
  • School Avoidance: The patient's dislike of attending school and report of being bullied could suggest a diagnosis of school avoidance, which could be contributing to the patient's physical symptoms.

Do Not Miss Diagnoses

  • Inflammatory Bowel Disease (IBD): Although less likely, IBD (such as Crohn's disease or ulcerative colitis) could present with similar symptoms and would require prompt diagnosis and treatment to prevent complications.
  • Appendicitis: Although the patient's symptoms are non-specific, appendicitis could present with abdominal pain, nausea, and vomiting, and would require urgent surgical intervention if suspected.
  • Peptic Ulcer Disease: The patient's epigastric pain could be related to a peptic ulcer, which would require prompt diagnosis and treatment to prevent complications.

Rare Diagnoses

  • Celiac Disease: Although less common, celiac disease could present with abdominal pain, diarrhea, and vomiting, and would require a trial of a gluten-free diet to diagnose and treat.
  • Mitochondrial Disorders: Certain mitochondrial disorders, such as mitochondrial neurogastrointestinal encephalomyopathy (MNGIE), could present with gastrointestinal symptoms, although these are rare and would require specialized testing to diagnose.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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