Marked Epigastric Tenderness in Medicine / Internal Medicine — 72yo Man | Gastroenterology | SMLE Q#910
SMLE Question #910
Medicine / Internal Medicine
Gastroenterology
Last updated: February 2026
A 72-year-old man has 7 days of severe constant epigastric pain that became suddenly worse, is sharp, radiates to the back, and is aggravated by movement and coughing. He had one episode of hematemesis 3 days ago and has taken high-dose ibuprofen daily for 2 months. He appears ill and lies still. Abdominal examination shows a rigid abdomen with marked epigastric tenderness, guarding, and absent bowel sounds. What is the most likely diagnosis?
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