A 44-year-old man presents to the emergency department (ED) with epigastric and mid-back pain for the past 1 week,

A 44-year-old man presents to the emergency department (ED) with epigastric and mid-back pain for the past 1 week, which he describes as burning, gnawing, and cramping. He rates pain as a 5 on a 0-to-10 scale between meals, which is relieved by eating but then returns again 2-3 hours later. Changes in dietary choices have not helped with pain. He has been taking calcium carbonate antacids 2-3 tabs in the middle of the night due to epigastric pain, waking him from sleep. He has also had nausea and vomiting during this time, has vomited two times today, and reports blood tinge with each occurrence. His last bowel movement was 2 days ago. He reports urinary frequency, having to void every 1-2 hours during the day, and having urine that is dark and concentrated. He reports a constant, dull headache and feeling more fatigued than usual, especially with activity, but is still able to perform his activities of daily living (ADLs) as usual. Physical assessment findings Pain to epigastric area with palpation Vital signs: BP: 135/86 mm Hg HR: 102 bpm RR: 20 breaths/min. pO2 94% on room air Temperature: 99.0oF (37.2oC) Abdomen is soft, nonbloated

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