Peptic ulcer Quiz: Ace Your Exams
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A 62-year-old man presents to the emergency department with severe abdominal pain and vomiting this morning. He states he has had abdominal pain for the past several weeks, with the pain acutely worsening today with radiation to the left shoulder. He reports the vomit was dark brown and had a granular consistency. Past medical history is significant for hypertension and hypercholesterolemia. He was also admitted for alcoholic pancreatitis approximately six weeks ago.The patient has smoked 1 pack of cigarettes daily for 30 years. He reports drinking 3-4 beers daily. Temperature is 37°C (98.6 °F), pulse is 111/min, respirations are 24/min, and blood pressure is 92/62 mmHg. Physical examination shows a pale man in acute distress. Abdominal examination is notable for diffuse tenderness to palpation, with rebound and rigidity. Laboratory results are shown below:
Abdominal imaging is most likely to reveal which of the following findings?
| Laboratory value | Result |
| CBC, Serum | |
| Hemoglobin | 10.1 g/dL |
| Hematocrit | 30% |
| Leukocyte count | 14,000 /mm3 |
| Platelet count | 160,000/mm3 |
| Serum | |
| Sodium | 132 mEq/L |
| Potassium | 4.2 mEq/L |
| Chloride | 95 mEq/L |
| BUN | 67 mg/dL |
| Creatinine | 2.6 mg/dL |
| Albumin | 3.7 g/dL |
| AST | 60 U/L |
| ALT | 30 U/L |
| Alkaline Phosphatase | 110 U/L |
| Bilirubin, total | .7 mg/dL |
| Lipase | 100 U/L |
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