A 35-year-old woman presents to the clinic with a 5-month history of intermittent abdominal pain and nonbloody diarrhea. She describes the pain as crampy and located in the lower abdomen. She reports unintentional weight loss and fatigue. She has no significant medical history and does not take any medications other than oral contraceptives. She does not use tobacco, alcohol, or illicit drugs. Her temperature is 36.9°C (98.4°F), blood pressure is 115/70 mm Hg, pulse is 80/min, and respirations are 14/min. On physical examination, the abdomen is soft, with mild tenderness to palpation in the lower quadrants but no rebound tenderness.
Laboratory results show the following:
Which of the following is the best next step in the evaluation of this patient’s condition?
The correct answer is:
A) Colonoscopy with evaluation of the terminal ileum
The patient's presentation of chronic abdominal pain, nonbloody diarrhea, weight loss, and laboratory findings of anemia, leukocytosis, and elevated ESR is suggestive of an inflammatory bowel disease, such as Crohn disease. Colonoscopy with terminal ileum evaluation for biopsy is the best next step to confirm the diagnosis and assess the extent and severity of the disease.
Answer choice B: CT scan of the abdomen, is incorrect. A CT scan of the abdomen can help identify complications of inflammatory bowel disease but is not the best initial diagnostic test.
Answer choice C: ERCP, is incorrect. ERCP is used to diagnose biliary and pancreatic disorders and is not relevant for this presentation.
Answer choice D: Hydrogen breath test, is incorrect. A hydrogen breath test is used to diagnose lactose intolerance and small intestinal bacterial overgrowth, which are less likely given the systemic inflammatory findings.
Answer choice E: Stool culture and ova and parasite exam, is incorrect. Stool culture and ova and parasite exam can help identify infectious causes of diarrhea but is not the best next step given the chronicity and systemic features of the patient's condition.
Key Learning Point
Inflammatory bowel disease should be suspected in a patient with chronic abdominal pain, non-bloody diarrhea, weight loss, anemia, leukocytosis, and elevated ESR. Colonoscopy with terminal ileum biopsy is the best next step to confirm the diagnosis and assess disease severity.
