A 53-Year-Old Man Comes to the Office Due to Intermittent

question 617

Multiple Choice

A 53-year-old man comes to the office due to intermittent abdominal pain for the past 6 months.  He describes the pain as sharp, located across his mid-abdomen, and relieved with sitting upright.  The patient also describes postprandial bloating and discomfort during these episodes.  He has observed that the pain is more noticeable shortly after meals.  The painful episodes last minutes to hours at a time and then spontaneously resolve.  His symptoms are becoming progressively more severe and frequent, but currently he is not experiencing pain.  The patient has frequent large, loose stools that require multiple flushes.  He reports being hospitalized multiple times in the past for abdominal pain but does not recall a specific diagnosis, and no records of these hospitalizations are available.  The patient has no dysphagia, odynophagia, vomiting, black stools, or blood in the stool.  He reports a 6.8-kg (15-lb) weight loss over the last 6 months.  The patient drinks 4 or 5 bottles of beer daily and occasionally liquor.  He does not smoke or use illicit drugs.  Medications include over-the-counter antacids and acetaminophen.  Temperature is 36.4 C (97.5 F) , pulse is 86/min, blood pressure is 122/78 mm Hg, and respirations are 12/min.  BMI is 21 kg/m².  The lungs are clear to auscultation.  The abdomen is tender to palpation, but soft and nondistended.  There is no rebound tenderness, rigidity, hepatomegaly, or splenomegaly.  The remainder of the physical examination is normal.  Laboratory results are as follows:

Which of the following tests is most likely to provide the diagnosis?

• A)Esophagogastroduodenoscopy
• B)Lactose breath hydrogen test
• C)Magnetic resonance cholangiopancreatography
• D)Serum anti-tissue transglutaminase antibody
• E)Serum lipase

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Definitions:

Objective Attributes

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Postpurchase Behavior

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Samsung Galaxy S10

A smartphone model developed by Samsung, launched as part of its Galaxy S series in 2019, known for its high-resolution camera and advanced features.