Question: A 20-year-old, previously healthy college student developed acute abdominal pain and vomiting. Symptoms started about 2 weeks before presentation. His pain was epigastric and nonradiating and the emesis was bilious and nonbloody. He reported weight loss of 30 lbs over the preceding 9 months. He has no history of alcohol use or previous abdominal surgery. On physical examination he has conjunctival icterus, abdominal distention, and diffuse abdominal tenderness without signs of peritonitis.