Q. A 38-year-old male presents to the emergency department with a sudden onset of severe abdominal pain and vomiting. He reports a similar episode last week that resolved on its own. The patient denies any fevers or known sick contacts. There is no history of trauma, or other associated symptoms. He has no significant past medical history and takes no medications regularly. The patient works as a security guard at a warehouse, and reports receiving a “flu shot” at work ten days ago. He denies any history of smoking, and does not drink alcohol. Physical examination demonstrates his blood pressure is 165/95 mm Hg, heart rate 90/min, respiratory rate 18/min, and oxygen saturation is 99 percent on room air. The patient weighs 130 kg (286 lb) and is 180 cm (5 ft 9 in) tall, with a BMI of 40 kg/m2. Auscultation of his chest reveals clear breath sounds bilaterally, and cardiac exam demonstrates a regular rhythm with no murmurs. On assessment of his abdomen, you detect moderate tenderness to deep palpation in the lower quadrants with acute pain radiating to his groin. You also note costovertebral angle tenderness on his right flank. Other than significant obesity, his remaining physical exam is unremarkable. You order an abdominal x-ray (see image). Based on the information you have at this point, which of the following is the most appropriate next step?