A 19-Year-Old Man Comes to the Office Due to a Change

question 317

Multiple Choice

A 19-year-old man comes to the office due to a change in bowel habits.  Six months ago, the patient began having loose, watery stools with increased frequency to approximately 5 times daily.  In addition, he has had crampy, intermittent abdominal pain that usually improves after defecation.  No nausea, vomiting, melena, fevers, night sweats, or weight loss has occurred.  The patient vacationed in South America 12 months ago.  He does not use tobacco or alcohol.  Temperature is 37.4 C (99.3 F) , blood pressure is 138/87 mm Hg, pulse is 75/min, and respirations are 12/min.  The patient appears comfortable and is not in acute distress.  There is no conjunctival pallor, scleral icterus, or palpable lymphadenopathy.  Cardiopulmonary examination is unremarkable.  The abdomen is nontender and nondistended.  Rectal examination reveals scant blood in the stool but no hemorrhoids or fissures.  Laboratory results are as follows: Stool studies are negative for ova and parasites as well as Clostridioides (formerly Clostridium) difficile.  Which of the following is the best next step in management?

• A)Check fecal calprotectin
• B)Check serum tissue transglutaminase
• C)Obtain a barium enema
• D)Obtain a colonoscopy
• E)Obtain a CT of the abdomen and pelvis
• F)Prescribe a course of azithromycin
• G)Recommend loperamide and a low FODMAP diet