ABSTRACT
A 55-year-old man has presented to the emergency department with abdominal pain and vomiting. He says the pain came on gradually yesterday. The pain is dull and constant, in the epigastrium and the centre of the abdomen and radiating to his back. He has had multiple previous admissions to hospital, which were primarily related to alcohol excess. He admits to drinking around 50 units of alcohol per week and has been drinking particularly heavily over the last fortnight. He smokes 20 cigarettes per day. Apart from some admissions related to trauma there is no significant medical history. His mother had type 2 diabetes but there is no other family history. He is divorced, lives alone in a flat and is unemployed.
