A 44-year-old woman presents to her general practitioner complaining of pain in her epigastrium radiating into her back. The pain developed 18 hours earlier and has become progressively more severe. She has not eaten for the last 24 hours and has vomited altered food and then fluid but no blood on 4 occasions. She has had some looseness of her bowel motions. She feels feverish and increasingly unwell and has no pain on passing urine and no urinary frequency. Her last menstrual period was 2 weeks ago. She has no other significant past medical history.
She smokes 15–20 cigarettes per day, drinks around half a bottle of wine each night. She has not used any recreational drugs. Medical observation She looks unwell with a body temperature of 38.8°C. Her pulse rate is 110/min, and blood pressure 102/64 mmHg. In the respiratory system, there is some dullness to percussion at the left base. She…
