Physical Examination

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General Appearance: Mild distress. Signs of dehydration, septic appearance. Note whether the patient appears ill, well, or malnourished.

Vital Signs: Pulse (tachycardia), BP (orthostatic hypotension), respiratory rate, temperature.

Skin: Pallor, delayed capillary refill.

Abdomen: Scars, mild to moderate epigastric tenderness; rebound, rigidity, guarding (perforated ulcer), bowel sounds.

Rectal: Occult blood.

Labs: CBC, electrolytes, BUN, amylase, lipase. Abdominal X-ray series, endoscopy.

Differential Diagnosis: Pancreatitis, gastritis, gastroenteritis, perforating ulcer, intestinal obstruction, mesenteric thrombosis, aortic aneurysm, gastroesophageal reflux disease, non-ulcer dyspepsia, hepatitis, cholecystitis.

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