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A 22-year-old man presents with bloody and tarry stools for the last month. The patient denies any associated symptoms and reports that he does not know his family history since he is adopted. Fecal occult blood test is positive and the patient has a hemoglobin level of 8.9 g/dL. Colonoscopy is performed and hundreds of colonic polyps are appreciated. Biopsy confirms that they are adenomatous polyps. What is the best next step in management for this patient's condition?Ask StudybuddyGroup of answer choicesRepeat colonoscopy and biopsy in 1 yearElective proctocolectomyMonthly FOBT and CEA levelsReassurance as the polyps are benign

Question

A 22-year-old man presents with bloody and tarry stools for the last month. The patient denies any associated symptoms and reports that he does not know his family history since he is adopted. Fecal occult blood test is positive and the patient has a hemoglobin level of 8.9 g/dL. Colonoscopy is performed and hundreds of colonic polyps are appreciated. Biopsy confirms that they are adenomatous polyps. What is the best next step in management for this patient's condition?Ask StudybuddyGroup of answer choicesRepeat colonoscopy and biopsy in 1 yearElective proctocolectomyMonthly FOBT and CEA levelsReassurance as the polyps are benign

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Solution

The best next step in management for this patient's condition is an elective proctocolectomy. This patient's presentation of numerous adenomatous colonic polyps and a positive fecal occult blood test is suggestive of Familial Adenomatous Polyposis (FAP). FAP is an autosomal dominant condition characterized by the development of hundreds to thousands of adenomatous colonic polyps. If left untreated, there is nearly a 100% chance of progression to colorectal cancer, typically by the fourth decade of life. Therefore, prophylactic colectomy is recommended for these patients.

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