A 3-Year-Old Boy Is Brought to the Office by His

A 3-year-old boy is brought to the office by his parents due to constipation.  The boy previously had soft stools 1-2 times daily.  However, over the past 3 months, his bowel movements have decreased to 1 stool every 3-4 days with significant straining and production of hard stool balls.  The boy has intermittent diffuse abdominal pain and increased irritability, but these symptoms have not affected his overall appetite.  Family history is notable for a maternal aunt with celiac disease and a paternal grandmother with "thyroid problems."  Four months ago, the boy and his parents moved into a house owned by their family for generations, and the parents are worried that the stress of the move might be contributing to his symptoms.  Height and weight have been tracking appropriately.  Physical examination shows a pale, tired boy with palpable stool in his abdomen but no abdominal tenderness.  Which of the following is the most appropriate diagnostic test for this patient?

A) Anorectal manometry
B) Blood lead level
C) Serum electrolytes
D) Serum thyroid-stimulating hormone
E) Serum tissue transglutaminase

Correct Answer:

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