Differential Diagnosis for Adolescent with Abdominal Pain, Weight Loss, and Decreased LDH
Single Most Likely Diagnosis
- Inflammatory bowel disease (IBD): This includes conditions like Crohn's disease and ulcerative colitis. The symptoms of abdominal pain and weight loss are common in IBD, and while LDH is not a specific marker for IBD, its decrease might be seen in the context of chronic disease where liver function tests could be affected, showing a mild decrease in LDH due to malnutrition or other metabolic changes associated with chronic illness.
Other Likely Diagnoses
- Celiac disease: An autoimmune reaction to gluten leading to small intestine damage, which can cause abdominal pain, weight loss, and malabsorption. Decreased LDH could be related to malabsorption and metabolic disturbances.
- Peptic ulcer disease: While more commonly associated with increased inflammation, chronic peptic ulcer disease could lead to weight loss and abdominal pain. The decrease in LDH might not be directly related but could be seen in the context of overall metabolic changes.
- Chronic pancreatitis: This condition causes abdominal pain and weight loss due to malabsorption. Decreased LDH could be part of the broader metabolic and nutritional deficiencies seen in chronic pancreatitis.
Do Not Miss Diagnoses
- Lymphoma: Although less common, lymphoma (especially non-Hodgkin lymphoma) can present with abdominal pain, weight loss, and alterations in various blood tests, including LDH. Elevated LDH is more commonly associated with lymphoma, but in some cases, especially with significant tumor lysis or specific types of lymphoma, LDH levels might be decreased.
- Tuberculosis: Abdominal tuberculosis can cause chronic abdominal pain, weight loss, and systemic symptoms. While LDH is not a specific marker, its decrease could be part of the broader spectrum of metabolic changes in chronic infection.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic abdominal pain, weight loss, and various metabolic disturbances. The decrease in LDH might be incidental or related to the metabolic effects of the tumor.
Rare Diagnoses
- Whipple's disease: A rare, systemic bacterial infection that can cause malabsorption, weight loss, abdominal pain, and various other symptoms. Decreased LDH could be part of the malabsorption and metabolic profile.
- Eosinophilic gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, leading to abdominal pain, weight loss, and gastrointestinal symptoms. The decrease in LDH might be related to the chronic nature of the disease and associated metabolic changes.
- Abdominal neuroblastoma: A rare tumor that can cause abdominal pain, weight loss, and systemic symptoms in children and adolescents. While LDH is a tumor marker for some cancers, its decrease in this context would be unusual and not directly diagnostic.