A 21-Year-Old Woman Comes to the Office Due to Constipation

A 21-year-old woman comes to the office due to constipation and vague abdominal pain.  She says, "For the last few months I have felt bloated and my stomach doesn't feel right."  Review of systems is notable for irregular menses and occasional fatigue.  Medical history is significant for a broken femur at age 6 but is otherwise noncontributory.  Family history is significant for Graves disease in her father and primary myelofibrosis in her paternal grandmother.  The patient smokes a pack of cigarettes daily and drinks wine when relaxing with friends.  She does not use illicit drugs.  Temperature is 37.2 C (99 F) , blood pressure is 90/60 mm Hg, pulse is 118/min, and respirations are 16/min.  BMI is 25.6 kg/m².  Physical examination shows eroded enamel of the teeth.Laboratory results are as follows: Which of the following is the most likely cause of this patient's condition?

A) Acute pancreatitis
B) Alcohol use disorder
C) Bulimia nervosa
D) Hypothyroidism
E) Irritable bowel syndrome
F) Sjögren syndrome

Correct Answer:

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