The diagnosis of RAP should be based on a careful history and
thorough physical examination that will point the clinician to a
presumed diagnosis or to focused diagnostic tests. A physical examination
should include a rectal examination and stool guaiac and an evaluation
for undescended testes, hernias, abdominal fullness, or masses.
Findings on history and physical examination that suggest the possibility
of an underlying organic disorder should serve as guide to laboratory
and other diagnostic tests. In general, extensive routine screening
tests are of low yield, especially in patients with an otherwise
normal history and physical examination. Screening radiographic
studies and endoscopies have particularly low yield without specific
clinical suspicions.19 A study by Wever et al20 examined
children with RAP by ultrasonography and found an abnormality in
7% of patients. However, other studies examining the use
of ultrasound in children with RAP have shown that abnormalities
found on ultrasound could have been predicted by history and physical
examination and focused laboratory testing. Extensive testing may
increase patient and parental anxiety and even reinforce a patient’s
sick role. In addition to a history and physical examination, baseline
complete blood count and urinalysis help rule out occult organic disease
such as inflammatory bowel disease and ureteropelvic junction obstruction.
In making the diagnosis of RAP, patients should have the characteristic
features with respect to age, chronicity, location of pain, and
absence of concerning findings on history and physical examination.
Any evidence of systemic illness on either history or physical examination
such as fever, rash, weight loss, joint pain, or failure to follow
growth curve should prompt further investigation of organic causes.21 Occurrence
of persistent or recurrent abdominal pain in a child younger than
4 years should also prompt further workup. A family history of inflammatory
bowel disease in a child with chronic abdominal pain warrants further
laboratory testing, such as sedimentation rate, and possibly further
diagnostic testing, such endoscopy and/or colonoscopy.21