Gastroenterology and Hepatology Q14

A 24-year-old man is evaluated in the emergency department for a 2-week history of worsening bloody diarrhea with up to 10 bloody bowel movements per day. He also reports increasing lower abdominal pain and distension and that stool frequency has decreased over the past day. He has extensive ulcerative colitis of 5 years' duration. His medications are infliximab and azathioprine.

On physical examination, the patient appears ill. Temperature is 38.3 °C (101 °F), blood pressure is 90/60 mm Hg, and pulse rate is 110/min; other vital signs are normal. The abdomen is distended with guarding. Bowel sounds are hypoactive.

Laboratory studies show a hemoglobin level of 10 g/dL (100 g/L), leukocyte count of 16,000/μL (16 × 109/L), and blood urea nitrogen level of 26 mg/dL (9.3 mmol/L).

An abdominal radiograph is shown.

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

Stool culture
 

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