Differential Diagnosis for a 9-year-old Girl with Abdominal Pain and Behavioral Changes
- Single most likely diagnosis:
- Functional Abdominal Pain associated with Anxiety or Depression: The patient's symptoms of intermittent abdominal pain, poor appetite, withdrawal, and decreased engagement in activities, combined with the recent stressors at home (father's job loss and return to drinking), suggest a strong link between her physical complaints and emotional distress. The lack of specific abdominal findings and the absence of other gastrointestinal symptoms support this diagnosis.
- Other Likely diagnoses:
- Anxiety Disorder: The patient's avoidance of social interactions, such as declining invitations to play at friends' houses, and her general withdrawal could indicate an anxiety disorder, which is often comorbid with functional abdominal pain.
- Depressive Disorder: The patient's statement about everything being better when no one has to take care of her anymore, along with her poor eye contact, withdrawal, and decreased interest in activities, suggests depressive symptoms.
- Somatic Symptom Disorder: This condition is characterized by one or more chronic physical symptoms (like abdominal pain) that are distressing and result in significant disruption of daily life, which seems to fit the patient's presentation.
- Do Not Miss diagnoses:
- Inflammatory Bowel Disease (IBD): Although the patient's symptoms do not strongly suggest IBD (e.g., no diarrhea, blood in stool, or weight loss), it is crucial to consider and rule out this condition due to its potential for severe complications if left untreated.
- Abdominal Malignancy: Though rare in children, abdominal tumors could present with nonspecific abdominal pain and should be considered, especially if the patient's condition does not improve with management of suspected functional or psychological causes.
- Child Abuse or Neglect: Given the father's recent job loss, return to drinking, and the family's financial difficulties, it's essential to be vigilant for signs of child abuse or neglect, which could manifest as physical complaints or behavioral changes.
- Rare diagnoses:
- Mitochondrial Disorders: These are a group of disorders caused by dysfunctional mitochondria, which can lead to a wide range of symptoms, including abdominal pain, but are relatively rare and would typically be associated with other systemic symptoms.
- Porphyrias: A group of rare genetic disorders that can cause abdominal pain among other symptoms, but are less likely given the patient's presentation and the absence of other characteristic symptoms like neurological manifestations or skin sensitivity.