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A 27-Year-Old Man Comes to the Physician Because of a 10-Day

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A 27-year-old man comes to the physician because of a 10-day history of crampy lower abdominal pain and diarrhea that awakens him at night.  He says he might have some blood in his stool, but he is not sure.  He also complains of fatigue.  His past medical history is unremarkable.  He takes a daily multivitamin and exercises regularly.  He has a stable male partner and uses condoms regularly.  His mother died of lymphoma and his older brother suffers from ulcerative colitis.
He is afebrile.  His blood pressure is 130/88 mm Hg, pulse is 90/min, and respirations are 12/min.  His bowel sounds are normoactive.  There is mild abdominal tenderness in both lower quadrants without rebound tenderness.  His examination is otherwise unremarkable.
The patient's labs reveal:
A 27-year-old man comes to the physician because of a 10-day history of crampy lower abdominal pain and diarrhea that awakens him at night.  He says he might have some blood in his stool, but he is not sure.  He also complains of fatigue.  His past medical history is unremarkable.  He takes a daily multivitamin and exercises regularly.  He has a stable male partner and uses condoms regularly.  His mother died of lymphoma and his older brother suffers from ulcerative colitis. He is afebrile.  His blood pressure is 130/88 mm Hg, pulse is 90/min, and respirations are 12/min.  His bowel sounds are normoactive.  There is mild abdominal tenderness in both lower quadrants without rebound tenderness.  His examination is otherwise unremarkable. The patient's labs reveal:   Which of the following is the best next step in managing this patient? A) Antimotility drugs B) Peripheral blood smear C) Empiric antibiotics D) Sigmoidoscopy E) Stool cultures
Which of the following is the best next step in managing this patient?


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