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a 46 year old woman brought to the emergency department with complain of one day of severe epigastric abdominal pain radiating to her back she notices several episodes of nausea and vomiting over this period of time she has experienced slighter pain in the past especially after heavy meals but it also went away after three to four hours but this time the pen was severe and intolerable and didnamp;#39;t improve so her family brought her to the emergency department she has no medical history and takes no medication she denies his story of alcohol consumption or smoking she is married and has two children on physical examination she is diaphoretic restless and moving uncomfortably on the stretcher but she is alert and can talk to the physician the escalator of each eye is ectaric her lungs expand normally and it is clear on auscultation the abdomen is soft with no distension but has tenderness on palpitation in epigastric area and right upper quadrant she has normal blood pressure normal
