Differential Diagnosis for 8-year-old Girl with Abdominal Pain and Vomiting
- Single most likely diagnosis:
- Functional abdominal pain: This is a common condition in children, characterized by recurrent abdominal pain without an identifiable cause. The intermittent nature of the symptoms and the absence of other alarming signs make this a plausible diagnosis.
- Other Likely diagnoses:
- Gastroenteritis: Given the history of intermittent diarrhea and vomiting, a viral or bacterial gastroenteritis could be a possible cause, especially if the symptoms are self-limiting.
- Constipation: Although not directly mentioned, constipation can cause abdominal pain and vomiting in children. The central abdominal tenderness could be related to a full rectum or hard stool.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can present with abdominal pain, vomiting, and diarrhea. The chronic nature of the symptoms over three weeks raises the possibility of IBD.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Appendicitis: Although the pain is central and not typically localized to the right lower quadrant, appendicitis can present atypically in children. It's crucial to consider this diagnosis due to the potential for severe complications if missed.
- Intussusception: A condition where a part of the intestine telescopes into another, which can cause intermittent abdominal pain, vomiting, and sometimes diarrhea. It's a surgical emergency.
- Midgut volvulus: A condition where the intestine twists around its base, cutting off blood supply. It's rare but can be fatal if not promptly treated.
- Rare diagnoses:
- Celiac disease: An autoimmune reaction to gluten that can cause abdominal pain, diarrhea, and vomiting. It's less common but should be considered in the differential, especially if the symptoms persist.
- Pancreatitis: Inflammation of the pancreas, which can cause severe abdominal pain, vomiting, and sometimes diarrhea. It's rare in children but can be seen in certain conditions or after trauma.
- Abdominal lymphoma: A type of cancer that can cause abdominal pain, vomiting, and weight loss. It's rare in children but should be considered if other diagnoses are ruled out and symptoms persist or worsen.