Differential Diagnosis for 8-year-old with Diarrhea for 3 weeks
Single most likely diagnosis
- Inflammatory Bowel Disease (IBD): The presence of diarrhea for 3 weeks, along with ketones and protein in the stool, suggests a chronic inflammatory process. IBD, which includes conditions like Crohn's disease and ulcerative colitis, is a common cause of chronic diarrhea in children and can lead to malabsorption and the presence of blood and protein in the stool.
Other Likely diagnoses
- Infectious Gastroenteritis: Prolonged infectious gastroenteritis, possibly due to a bacterial, viral, or parasitic infection, could explain the chronic diarrhea. The presence of ketones might indicate a degree of malabsorption or dehydration.
- Celiac Disease: An autoimmune reaction to gluten can cause chronic diarrhea, malabsorption, and the presence of ketones due to fat malabsorption. Protein in the stool could be seen in advanced cases with significant intestinal damage.
- Lactose Intolerance or Other Carbohydrate Malabsorption: These conditions can lead to chronic diarrhea, especially if the child continues to consume lactose or other poorly absorbed carbohydrates. However, the presence of protein in the stool is less typical.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Intussusception: Although more commonly associated with acute abdominal pain and vomiting, intussusception can occasionally present with chronic symptoms, including diarrhea. It's a surgical emergency.
- Hirschsprung's Disease: Typically diagnosed in infancy, late presentations can occur. The disease involves an aganglionic segment of the colon leading to obstruction and potentially chronic diarrhea if there's a partial obstruction.
- Neonatal or Infantile Disorders (e.g., Congenital Diarrheal Disorders): Though less likely in an 8-year-old, some congenital conditions can present later in childhood, especially if they were mild or partially compensated.
Rare diagnoses
- Tumor (e.g., Neuroblastoma, Lymphoma): Though rare, abdominal tumors can cause chronic diarrhea among other symptoms, depending on their location and effect on surrounding tissues.
- Immunodeficiency States: Conditions like HIV or primary immunodeficiencies can lead to chronic diarrhea due to opportunistic infections or malabsorption.
- Short Bowel Syndrome: Usually resulting from significant surgical resection of the small intestine, this condition can lead to chronic diarrhea and malabsorption. It's rare in a child without a history of significant intestinal surgery.