This is a 87 year old female NH resident with a history of chronic atrial
   fibrillation, hypertension and hypothyroidism who presents to the 
   [**Hospital Unit Name 10**].  She had been in her usual state of health until 5
   days ago when she suddenly began to have abdominal pain.  Her abdominal
   pain was initially intermittent lasting for a few hours at at time.  No
   clear correlation with food.  Yesterday, she noticed that her pain was
   much more severe, [**3301-9-5**] in severity and more localized to the right.
   This was accompanied by nausea and vomitting.  She vomitted twice, with
   clear liquid emesis and was sent to [**Hospital3 **].  
   At [**Hospital1 **], she was noted to have elevated amylase/lipase to 538 and 516
   with elevated bili to 4.1 and AST/ALT to 198/115 and was given
   ciprofloxacin, flagyl and 500cc NS and was transferred to the [**Hospital1 1**]
   emergency department.
   .
   At [**Hospital1 1**] EDVS 97.9  HR 83  157/92  RR 18  97% RA.  
   
   Elderly F, oriented X 2, NAD, flat jvp, CTA decreased b/b, s1 s2  
   [**Last Name (un) **], decreased BS, + t at
   ruq, no edema