He denies any previous surgical procedures and his only medical problems include diet-controlled diabetes mellitus and a history of peptic ulcer disease treated medically. His present alcohol consumption includes two to three mixed drinks per day and 12 to 15 beers each weekend. There is mild scleral icterus present. The chest is clear. The abdomen is soft but markedly tender in the epigastrium with rebound.
Bowel sounds are absent.
There are no palpable masses. Rectal exam reveals guaiac negative stool. A chest x-ray reveals a pleural effusion on the left side with some haziness of the lung fields. White blood cell count is 14,000 with 12 bands. Hemoglobin is 14.2, hematocrit 48, electrolytes within normal limits.