Ultrasound of the abdomen or pelvis is not useful in the absence of alarm symptoms. When
atypical symptoms are present, such as jaundice,23 urinary symptoms, back or fl ank pain,
vomiting, or abnormal fi ndings at physical examination, abdominal and pelvic ultrasound is
more likely than not to detect an abnormality. Endoscopy with biopsy in the absence of alarm
symptoms similarly fails to reveal organic disease.23 Insuffi cient evidence exists to suggest that
the use of esophageal pH monitoring in the absence of alarm symptoms results in fi nding
organic disease.23 In patients who experience recurrent vomiting, an upper gastrointestinal
series should be considered to defi ne potential anatomic abnormalities such as gastric outlet
disorder or malrotation. Th e choice of radiologic test should be guided by the diff erential
diagnosis generated by the history and the physical examination.
atypical symptoms are present, such as jaundice,23 urinary symptoms, back or fl ank pain,
vomiting, or abnormal fi ndings at physical examination, abdominal and pelvic ultrasound is
more likely than not to detect an abnormality. Endoscopy with biopsy in the absence of alarm
symptoms similarly fails to reveal organic disease.23 Insuffi cient evidence exists to suggest that
the use of esophageal pH monitoring in the absence of alarm symptoms results in fi nding
organic disease.23 In patients who experience recurrent vomiting, an upper gastrointestinal
series should be considered to defi ne potential anatomic abnormalities such as gastric outlet
disorder or malrotation. Th e choice of radiologic test should be guided by the diff erential
diagnosis generated by the history and the physical examination.
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