This is a 41-year-old male patient with medical history of alcohol abuse, cholelithiasis, hypertension, obesity who presented to his local hospital with hematemasis.  On Friday evening he had several episodes of vomiting of bright and dark red material.  In the emergency department, initial vs were: T 98.6 P66 BP145/89 R16 O2 sat 98% RA. He was started on a protonix gtt and octreotide gtt given his elevated liver function tests. Lab tests show elevated lipase,  pancytopenia and coagulopathy. He had a right upper abdominal quadrant ultrasound which demonstrated gallstones and sludge and ascites. As such given new ascites and abdominal pain he was given levofloxacin 750mg IV and flagyl 500mg IV reportedly for spontaneous bacterial peritonitis prophylaxis.  On the floor, he reports that he had two episodes of vomiting of dark red emesis.  Per his nurse it was about 75ml and was gastrocult positive.  He has right upper abdominal quadrant pain radiating to his back.  He also reports slow increase in abdominal girth with more acute distention and lower extremity swelling over the two days prior to admission.  The patient denies fever, chills, night sweats, headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. He also denied chest pain or tightness.