A 42-year-od man comes to the emergency department w th sudden-onset severe abdominal pain and 2 episodes of vomiting. He
rates h s pain as 9/1 o n severity with rad at on to the back. He has never experienced these symptoms before and has no other
med cal problems. The patent admits lo b nge drink ng last night whi e watching a football game on television. H s temperature is
37.7 C (99.9 F), b ood pressure is 112/70 mm Hg, pulse is 102/min, and respirations are 16/min. There is epigastr c tenderness on
papation of the abdomen but no rig d ty. There is no evidence of hematemesis, and a guaiac smear is negative. Initial laboratory
findings include a normal hemog obin and teukocytosis. A chest rad ograph and eectrocard ogram are normal. Which of the following
is the best next step in management of this patient?
- O A Abdominal computed tomography scan
- 0 B. Abdominal u trasound
- 0 C. Abdom nal upr ght x-rays
- O 0. Endoscopic retrograde cholangiopancreatography
- O E. Serum amylase and ipase
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