Differential Diagnosis for a 5-year-old Female with Chronic Intermittent Abdominal Pain
- Single Most Likely Diagnosis
- Functional abdominal pain (FAP): This is the most likely diagnosis given the chronic and intermittent nature of the pain, its diffuse and umbilical location, and the absence of alarm signs such as weight loss, vomiting, or blood in stool. The fact that the pain is worse in the morning and not related to eating also supports this diagnosis.
- Other Likely Diagnoses
- Constipation: Although not directly indicated, constipation is a common cause of abdominal pain in children and can present with intermittent pain, especially if the child has a bowel movement pattern that is irregular.
- Lactose intolerance or other dietary intolerances: Despite the negative tests for celiac disease (TTG antibody and gliadin antibody IGA negative), an equivocal gliadin antibody IGG suggests the possibility of a non-celiac gluten sensitivity or another dietary intolerance, which could cause abdominal pain.
- Do Not Miss Diagnoses
- Inflammatory bowel disease (IBD): Although the occult blood and stool tests were negative, IBD (including Crohn's disease and ulcerative colitis) must be considered due to its potential severity and the need for early intervention. The absence of typical symptoms like diarrhea or visible blood does not rule out IBD.
- Intussusception: This condition, where a part of the intestine slides into an adjacent part, can cause intermittent abdominal pain and is a medical emergency. It's more common in younger children but should be considered, especially if the pain pattern changes or if there are signs of obstruction.
- Urinary tract infection or kidney stone: The negative UA does not completely rule out a urinary tract issue, especially if the sample was not properly collected or if the infection is not causing typical symptoms like dysuria or frequency.
- Rare Diagnoses
- Celiac disease with atypical presentation: Although the tests for celiac disease were largely negative, an equivocal result for one of the antibodies and the fact that some individuals with celiac disease may have atypical or minimal gastrointestinal symptoms mean that this diagnosis cannot be entirely ruled out without further evaluation, such as an intestinal biopsy.
- Abdominal migraines: These are recurrent episodes of severe abdominal pain, often accompanied by other symptoms like headache, nausea, or vomiting, and can be considered in the differential diagnosis of chronic abdominal pain in children.
- Chronic intestinal pseudo-obstruction: A rare condition characterized by recurrent episodes of abdominal pain, nausea, vomiting, and altered bowel habits, mimicking a true mechanical obstruction without any physical blockage.