Approach to upper abdominal pain Quiz: Ace Your Exams
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A 55-year-old man comes to the emergency department for evaluation of recurrent mid-epigastric abdominal pain. The patient reports that his symptoms worsen with eating and drinking alcohol. The patient has a past medical history of alcohol use disorder, hypertension, and arthritis for which he takes ibuprofen daily. The patient has no history of surgeries. Temperature is 37°C (98.6°F), blood pressure is 123/66 mmHg, pulse is 78/min, respiratory rate is 16/min, and oxygen saturation is 97% on room air. Physical examination reveals tenderness to palpation in the epigastrium. Rectal examination is positive for hemoccult blood. Initial laboratory findings are detailed below. Based on the most likely diagnosis, which of the following is the next best step in management?
| Laboratory value | Result |
| Complete Blood Count (CBC) | |
| Hemoglobin | 10.1 g/dL |
| White blood cell count (WBC) | 8,000/mm3 |
| Liver Function Tests | |
| Alkaline Phosphatase (ALP) | 166 u/L |
| Alanine aminotransferase (ALT) | 47 u/L |
| Aspartate aminotransferase (AST) | 55 u/L |
| Total bilirubin | .7 mg/dL |
| INR | 1.1 |
| Serum chemistry | |
| Lipase | 50 u/L |
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