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. Serum amylase is 4,280 with a 1-hour urine amylase of 2,000 units. Creatinine is 1.1, BUN 25, calcium 7.4, glucose 24.0.