A 22-year-old female is being evaluated for diarrhea, steatorrhea, iron deficiency anemia and elevated liver function tests. She has intermittent 2/10 vague, dull abdominal pain “lasting minutes to hours” that gets better with defecation. She denies traveling abroad or abusing laxatives but cannot tolerate certain foods and beverages. She is currently undergoing evaluation for possible celiac disease. Anti-tissue transglutaminase, anti-endomysial antibodies, endoscopic visualization, and biopsies are all negative for celiac disease.  IgE testing for wheat allergy is also negative.  What is the probable diagnosis and what should be done next?

A 48-year-old man presents with severe abdominal pain in the mid-epigastric region. The pain began 3 days ago with an intensity of 10/10, concurrent nausea, and two recent episodes of emesis. The patient denies any significant past medical history. The findings on the physical exam are: Vital signs: BP: 86/58 Pulse: 112 Temp: 101.5° F. There is rebound tenderness in the mid-epigastric area, absent bowel sounds, and a positive Cullen sign. The rest of the physical examination is within normal limits. What are the two most common causes of this condition?

A 64-year-old woman presents for evaluation of recent loss of appetite, abdominal cramps, constipation, and “bright red blood” in her stool.  The patient reports that she was in good health until approximately 6 weeks ago, when she noted occasional cramps in the left lower quadrant of the abdomen associated with constipation. The episodes of cramping last about 30 minutes each and are most severe in the hour following her meals. She has taken laxatives which have partially relieved her symptoms, but she has had a decreased appetite and 12-pound weight loss over the past four weeks. In addition, she has become increasingly fatigued over this period. When questioned about her bowel  habits, she reported bright red blood in her stools and a smaller caliber (i.e. diameter) of stool over the past two weeks.   She appeared fatigued and distressed. Head and neck exams were normal, as was her thorax. Palpation of the abdomen revealed a 10 x 10 cm mass and tenderness in the left lower quadrant. Hepatomegaly was noted, and a hard and slightly tender liver edge was felt in the right upper quadrant. Bowel sounds were noticeably reduced.   Based on this information, which of the following conditions would you consider to be the most likely cause of the patient’s symptoms?

A 46-year-old female with PMH significant for Type II DM, presents to the clinic for evaluation of 2-3 episodes of sudden, severe epigastric pain which radiates to her shoulder.  She has associated nausea and vomiting.  The patient has a fever of 101ºF, and reports that she is experiencing chills.  The patient is also noted to have scleral icterus.  Based on this information, which of the following conditions is the most likely diagnosis in this patient?

A 52-year-old male presents to the ER with acute, severe, epigastric pain radiating to the back.  The patient reports one episode of coffee ground emesis earlier that day.  On examination, the patient is ill-appearing with a rigid, quiet abdomen and rebound tenderness.  Which of the following conditions is the most likely diagnosis for this patient?

Esophageal strictures have many potential etiologies, including benign and malignant conditions.  Patients with esophageal stricture typically initially present with which of the following symptoms?

A patient with abdominal pain is found to have free intraperitoneal air under the diaphragm on an upright chest x-ray.  This finding is most consistent with which of the following diagnoses?

A 68-year-old male with PMH significant for chronic alcohol abuse presents with a history of confabulation, confusion, and loss of memory. On examination he is found to have nystagmus, ataxia, and slight bilateral ophthalmoplegia. Which of the following vitamin deficiencies is the most likely cause of this patient’s symptoms?

A 74-year-old male presents with acute left lower quadrant abdominal pain.  He has nausea, vomiting, and constipation.  He currently has a fever of 101ºF.  On examination, he has guarding and rebound tenderness in his left lower quadrant.  His WBC is elevated.  The patient has no prior history of gastrointestinal disease.  Which of the following conditions is the most likely diagnosis?

A 30-year-old female patient presents with a complaint of rectal pain that has been going on for about a week. She says she has lost 4 pounds (2 kg) over the past four weeks, has a low-grade fever, and has noticed a foul discharge in her undergarments. She also complains of vague abdominal pain and anorexia. The patient has no significant PMH.  She has no allergies. She has never had surgery before. A physical exam reveals a visibly distressed female with tenderness in the anal area. Examination is performed under anesthesia and reveals multiple fistulous tracts just above the dentate line. She has frank pus extruding in the anal canal. Which of the following statements about this condition is true?