12-12-2008, 07:37 PM
A 45-year-old man is evaluated for a 6-month history of midabdominal pain, fatigue, and a 2.26-kg (5-lb) weight loss. He has a long-standing history of constipation-predominant irritable bowel syndrome (IBS) but reports the current abdominal pain is different from that associated with his previous IBS symptoms. He has no diarrhea, hematochezia, melena, or genitourinary complaints. He denies alcohol or drug use and has undergone no previous surgical procedures.
Physical examination is normal except for moderate obesity (weight of 118 kg [260 lb]) and some mild, midabdominal tenderness but no hepatosplenomegaly, masses, guarding, or rebound tenderness. Laboratory studies, including hemoglobin, serum creatinine level, liver chemistry tests, serum lipase level, and urinalysis, are normal. Results of colonoscopy are also normal.
Which of the following is the most appropriate next radiologic imaging test for this patient?
A MRI of the abdomen
B Magnetic resonance cholangiopancreatography
C CT of the abdomen
D CT colonography
E Abdominal ultrasonography
Physical examination is normal except for moderate obesity (weight of 118 kg [260 lb]) and some mild, midabdominal tenderness but no hepatosplenomegaly, masses, guarding, or rebound tenderness. Laboratory studies, including hemoglobin, serum creatinine level, liver chemistry tests, serum lipase level, and urinalysis, are normal. Results of colonoscopy are also normal.
Which of the following is the most appropriate next radiologic imaging test for this patient?
A MRI of the abdomen
B Magnetic resonance cholangiopancreatography
C CT of the abdomen
D CT colonography
E Abdominal ultrasonography