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Case #1

History
71 year old white female presents to the ED with nause vomiting and epigastric pain. The pain began the previous day, about an hour after she ate a fish sandwich at a fast food restaurant.She now has continued symptoms, as well as dark brown emesis

She has a history of asthma, hypertension, an appendectomy and a hiatal hernia

Her medicines were: prednisone, theophylline preparation, beta adrenergic inhaler, ranitidine and iron supplements

Physical Exam
She was vomiting in the ED. The patient was not orthostatic, had a blood pressure of 148/90, a heart rate of 98 and a respiratory rate of 24. Temperature was 96.6F orally

The skin, HEENT, cardiac and neurologic exam were unrevealing. She has occasional end expiratory wheezes on auscultation.

Her abdomen was obese, and soft with some increased bowel sounds. She had mid epigastric tenderness, and the rest of her abdomen was non - tender. There was no rebound tenderness or other signs of peritonitis. No masses were appreciated. She had no costovertebral angle tenderness. Her stool was black, but was occult blood negative.
 

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