Differential Diagnosis for a 12-year-old with Abdominal Pain and Vomiting
Single Most Likely Diagnosis
- Viral Gastroenteritis: This is the most common cause of abdominal pain and vomiting in children, often accompanied by diarrhea, but can present without it. The diagnosis is usually clinical, based on symptoms and the absence of other alarming signs.
Other Likely Diagnoses
- Appendicitis: Although classically presents with right lower quadrant pain, early appendicitis can cause more generalized abdominal pain and vomiting. It's a surgical emergency if suspected.
- Constipation: Can cause significant abdominal pain and vomiting, especially if the constipation is severe and leads to bowel obstruction.
- Gastroesophageal Reflux Disease (GERD): Can cause abdominal pain and vomiting, especially after eating or at night.
- Urinary Tract Infection (UTI): While more common in younger children, UTIs can cause abdominal pain and vomiting in older children, especially if the infection involves the kidneys.
Do Not Miss Diagnoses
- Intussusception: A condition where a part of the intestine slides into another, causing bowel obstruction. It's a surgical emergency and can present with abdominal pain, vomiting, and sometimes currant jelly stool.
- Midgut Volvulus: A twisting of the intestine that can cut off blood supply, leading to tissue death. It's a surgical emergency and can present with abdominal pain and vomiting.
- Appendicitis with Perforation: If appendicitis is not promptly treated, the appendix can rupture, leading to peritonitis, a life-threatening condition.
- Pyloric Stenosis: More common in infants but can occur in older children, causing projectile vomiting after feeding.
Rare Diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic abdominal pain, vomiting, and changes in bowel habits.
- Hernias: Incarcerated or strangulated hernias can cause severe abdominal pain and vomiting, requiring emergency surgery.
- Pancreatitis: Inflammation of the pancreas, which can be caused by various factors, including gallstones, certain medications, and genetic conditions.
- Adrenal Insufficiency: A rare condition where the adrenal glands do not produce enough cortisol and aldosterone, leading to abdominal pain, vomiting, and other systemic symptoms.