A 55-year-old man has presented to the emergency department with abdominal pain and vomiting. He says the pain came on gradually yesterday. The pain is dull and constant, in the epigastrium and the center of the abdomen and radiating to his back. The patient admits having a habit of heavy drinking and smoking. Past Medical History : Apart from some admissions related to trauma, there is no significant medical history.

His mother had type 2 diabetes but there is no other family history. Examination This man’s upper abdomen is very tender but soft. His bowel sounds are normal. His heart rate is 110/min, blood pressure 112/74 mmHg. Investigations White cells                          19.4 10 9 /L Haemoglobin                      13.1 g/dL Platelets                              160 10 9 /L Sodium                                142 mmol/L Potassium                           3.9 mmol/L…