Irritable bowel syndrome Quiz: Ace Your Exams

A 24-year-old medical student presents to the urgent care clinic for evaluation of crampy abdominal pain that has been severe and constant for three hours. She has been under a lot of stress lately since starting her surgery rotation. During the past six months, she has had several episodes of diarrhea occurring during the day after meals. She reports non-radiating mid-abdominal pain, nonbloody diarrhea, and frequent flatulence over the same time frame. The pain is often worse during defecation. She has no family history of colon cancer or other gastrointestinal malignancies. Temperature is 37°C (98.7°F), pulse is 70/min, and blood pressure is 115/70 mmHg. Physical examination reveals mild diffuse abdominal tenderness on palpation without rebound or guarding. No abnormalities are seen on perianal and rectal examination. Laboratory studies show a normal CBC and a negative tissue transglutaminase IgA (tTg-IgA). Which of the following additional findings would be consistent with this patient’s condition?