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Question category: Gastroenterology

A 50 year old farm worker presents with a one year history of feeling generally unwell with arthralgia, fever, cough and chest pain. He has also notice that he has intermittent diarrhoea. On examination you find evidence of finger clubbing and a purpuric rash. In the abdomen you find hepatomegaly and a pansystolic murmur is heard of auscultation of the heart. Bloods reveal deranged LFTs and a high ESR and CRP. What investigation would you order to make the definitive diagnosis?

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