History of Present Illness (HPI)
A 50 year old Caucasian man presented to the emergency room with one day of severe stabbing epigastric pain, that is worse with lying flat and after oral intake. He thinks the pain occasionally moves to his right flank. The pain was originally intermittent but has been constant for the last 12 hours. He has had multiple episodes of nausea and non-bilious vomiting and can no longer keep orals down. He has had prior self-limited episodes of crampy abdominal pain after eating (particularly fatty foods), but they were never this intense. He denies any change in bowel habits, chest pain or shortness of breath.
He has a past medical history of a seizure disorder, rheumatoid arthritis, obesity, and hypertension. He is on daily valproate, 6-mercaptopurine, and amlodipine. He intermittently takes ibuprofen for breakthrough arthritis pain. He has had a prior appendectomy, and denies any relevant family history. He is a non-smoker and denies use of illicit drugs. He denies current alcohol consumption but from the age of 18 until the age of 35 he used to drink 6-8 drinks on the weekends.
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