Differential Diagnosis for Paediatric Abdominal Pain (Epigastric)
Single Most Likely Diagnosis
- Viral Gastroenteritis: This is often the most common cause of abdominal pain in children, characterized by inflammation of the stomach and intestines, usually due to a viral infection. Symptoms include epigastric pain, nausea, vomiting, and diarrhea.
Other Likely Diagnoses
- Constipation: Although more commonly associated with lower abdominal pain, constipation can sometimes cause epigastric discomfort in children, especially if the constipation is severe.
- Gastroesophageal Reflux Disease (GERD): GERD can cause epigastric pain and discomfort, especially after eating, due to the reflux of stomach acid into the esophagus.
- Peptic Ulcer Disease: Though less common in children than in adults, peptic ulcers can cause significant epigastric pain, especially when the stomach is empty.
Do Not Miss Diagnoses
- Appendicitis: Although appendicitis typically presents with right lower quadrant pain, it can initially cause epigastric pain before localizing. Missing this diagnosis can lead to severe consequences, including perforation and peritonitis.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, intussusception is a medical emergency that can cause severe abdominal pain, including epigastric pain, and must be promptly diagnosed and treated.
- Pyloric Stenosis: Commonly presenting in infants, pyloric stenosis involves the narrowing of the pylorus, the region of the stomach that leads to the small intestine, causing projectile vomiting and epigastric pain.
Rare Diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis are less common in children but can cause chronic abdominal pain, including epigastric pain, along with other symptoms like diarrhea and weight loss.
- Pancreatitis: Inflammation of the pancreas can cause severe epigastric pain and is a rare but serious condition in children, often associated with gallstones, certain medications, or genetic conditions.
- Hepatitis: Inflammation of the liver can cause upper abdominal pain, including epigastric pain, and is essential to diagnose due to its potential impact on liver function and the need for specific treatment.