MKSAP: 42-year-old woman with crampy abdominal pain

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 42-year-old woman is evaluated for an 8-month history of crampy abdominal pain and three loose bowel movements per day. The pain is relieved by a bowel movement. There are no nocturnal bowel movements, and there is no blood or dark tarry material in the stool. She has not had fever, night sweats, or weight loss. She has a history of Hashimoto disease and is treated with levothyroxine. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 128/84 mm Hg, pulse rate is 64/min, and respiration rate is 16/min; BMI is 23. No rash is noted. There is mild diffuse abdominal tenderness without peritoneal signs and no abdominal masses. Rectal examination is normal. Complete blood count and thyroid-stimulating hormone level are normal. Which of the following is the most appropriate next step in management? A: Breath test for bacterial overgrowth B: Colonoscopy with random biopsies C: Stool culture D: Tissue transglutaminase antibody testing 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: Journals (General) Authors: Tags: Conditions GI Source Type: blogs