Gastroenterology and Hepatology Q22

A 39-year-old woman is evaluated for fatigue, intermittent rectal bleeding, and abdominal pain over the past 2 months. She reports that the bleeding is not accompanied by anal pain or itching. She has experienced an unintentional 2.3-kg (5.1-lb) weight loss since her symptoms started. She has no personal or family history of colon cancer or other cancers. She takes no medication.

On physical examination, her pulse rate is 102/min; other vital signs are normal. BMI is 22. Abdominal examination reveals mild tenderness in the left lower quadrant with no rebound or guarding. Rectal examination shows no masses. Large, friable hemorrhoids are present.

Laboratory studies show a hemoglobin level of 10.5 g/dL (105 g/L) and a serum ferritin level of 5 ng/mL (5 µg/L).

Which of the following is the most appropriate next step in management?

Topical hemorrhoid treatment

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