MKSAP: 32-year-old woman with weight loss, abdominal cramping, and loose stools

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has not noted any blood associated with her bowel movements. Although her appetite is good, she has lost 3.2 kg (7.0 lb). She has an 8-year history of diffuse cutaneous systemic sclerosis. On physical examination, temperature is normal, blood pressure is 146/92 mm Hg, pulse rate is 94/min, and respiration rate is 16/min. BMI is 19. Cardiopulmonary examination is normal. The abdomen is soft and nontender with normal bowel sounds. Diffuse skin thickening of the face, anterior chest, and distal extremities is noted as well as sclerodactyly and multiple healed digital pits. There is no rash. Muscle strength and reflexes are normal. Laboratory studies: Albumin 2.6 g/dL (26 g/L) Alanine aminotransferase Normal Aspartate aminotransferase Normal Total bilirubin Normal Lipase Normal Urinalysis Normal Which of the following is the most appropriate diagnostic test to perform next? A. Colonoscopy B. CT of the abdomen and pelvis with contrast C. Endoscopic retrograde cholangiopancreatography D. Glucose hydrogen breath test Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Gastroenterology Rheumatology Source Type: blogs