Clinical Scenario

Mr. James Hewitt, 52, builder. Presents to A&E with a 12-hour history of severe epigastric pain radiating to the back, associated with nausea and two episodes of vomiting. He drinks approximately 40 units of alcohol per week. On examination he is tachycardic (HR 108), febrile (38.1°C), and has epigastric tenderness with guarding. Serum amylase is 1,240 U/L. He was admitted with a similar episode 3 weeks ago and discharged after 4 days.

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