Inflammatory bowel disease (ulcerative colitis) Quiz: Ace Your Exams

A 25-year-old man presents to the primary care clinic with a history of frequent bloody loose stools and generalized abdominal pain that started 3 months ago and has progressively worsened. The patient has also been feeling fatigued and has had an unintentional weight loss of 6.6 lbs (3 kg) in the past 3 months. He has no past medical history and is not currently taking any medications. He has a sedentary lifestyle and has no history of recent travel. He is sexually active with his partner and uses condoms consistently. BMI is 31 kg/m2. Vital signs are within normal limits. Physical examination is significant for mild generalized abdominal tenderness on palpation, bright red blood on digital rectal exam, and a painful ulcer with a purulent base and violaceous border on the right abdomen. Laboratory findings are significant for a hemoglobin of 10.8 g/dL, a mild elevation in CRP, and a positive fecal occult blood test. Which of the following will most likely establish the diagnosis of this patient’s underlying disease?