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A 45 year old male with a history of alcohol abuse presents to the emergency department with acute nausea and epigastric abdominal pain for the past 5 hours. He appears to be in significant distress and is clutching his abdomen. A stat chest x-ray is unremarkable and shows no evidence of free air under the diaphragm. The patient is given IV narcotics, antiemetics, and fluid, and an NG tube is placed with relief of his symptoms. Blood work is notable for an extremely elevated lipase.