A 22-year-old..................................... - mule

[ArchivalUser]

A 22-year-old college student comes to the clinic because of abdominal pain and diarrhea. He has had diffuse crampy abdominal pain intermittently for the last 4 months. He also has occasional episodes of watery diarrhea and has seen bright red blood in his stool several times. He denies fever, nausea, vomiting, or recent travel. He has no significant medical problems and does not take any medications. Vital signs are: 38.1OC (100.6OF), blood pressure 120/80 mm Hg, and pulse 70/min. Abdominal examination is significant for diffuse guarding and tenderness. He went to the emergency department 1 week ago with similar symptoms and had a CT of the abdomen and pelvis performed. The CT demonstrated a thickening of the terminal ileum and the remaining bowel appeared unremarkable. The most appropriate next step in management is to

A. Advise him to eat a gluten free diet
B. Order a colonoscopy
C. Order an upper gastrointestinal (UGI) barium study
D. Prescribe broad-spectrum antibiotics
E. Prescribe steroids

[ArchivalUser]

B. Order a colonoscopy

[ArchivalUser]

Try again aiissman

[ArchivalUser]

A........

[ArchivalUser]

Upper GI barium. This is most probably Crohns. But since the terminal illeum is involved conoscope may not be able to visualise it probably.

[ArchivalUser]

hot, your explanation may be rt.

[ArchivalUser]

rt hotobhaga

This patient's symptoms of abdominal pain and watery bloody diarrhea are suspicious for inflammatory bowel disease. The CT finding of terminal ileum thickening is suggestive of Crohn disease. The diagnosis of Crohn's disease is often made by an upper gastrointestinal (UGI) barium study. Classic findings include deep ulcers and discontinuous or "skip" inflammatory lesions in the small bowel. Complications include stricture and fistula formation. Colonoscopy is also useful if colon involvement is suspected.