What's your first thought? | Figure 1

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What's your first thought?

Picked up a pt from rehab facility going home. 65 yo male. History of CVA and diabetes. Couldn't get a read on the automatic blood pressure machine. Manual preformed and got 92/48. Tachy resting HR of 136. Respirations at 26. Pt complained of "stomach pains." Pt stated he had been vomiting for 3 days prior and he thought the reason he was in pain was sore muscles from vomiting. LUQ was rigid but most pain was towards the middle of the upper part of the abdomen. We took him to the ER instead of home. What would your first thoughts be of a diagnosis?

(I was able to find out later what the diagnosis was. Just curious what others think 🙂)

Similar cases

2 yof, previous healthy kid. Three days of abdominal pain, vomiting, drowsiness, abdomimal distension. Then this sign appeared. What do you think? Amilase and lipase slightly elevated (150 and 125).

male pt 40 ys old presented to ER with acute abd pain started 3 days ago then 2 days later developed vomiting . With absolute constipation from start of pain .. pt know presented with surgical abdomen .. exploration revels sigmoid volvulus ...

44 yr old female patient presented with gallstone pancreatitis. She had a laparoscopic cholecystectomy during same admission and was discharged home. She presented five weeks later with the epigastric pain, nausea, and vomiting. What is your diagnosis? Treatment options?

A 26-year-old woman with the Peutz–Jeghers syndrome presented to the emergency department with abdominal pain and nonbilious vomiting. A tender mass was palpable in the upper abdomen. What is the most likely diagnosis?
Acute necrotizing pancreatitis
Cholangiocarcinoma
Gastric leiomyosarcoma
Gastrogastric intussusception
Pancreatic adenocarcinoma with gastric invasion.