acute epigastric pain

Chief compliants: came with c/o pain since 1pm (5/7/23) in epigastric region(around last 4 hours)
HOPI: pt was apparently asymptomatic till 1pm then developed epigastric pain which is insidious in onset gradually in progression 
No compliants of vomiting  ,loose stools,fever , sob, pnd ,orthopnea chest pain.
History of similar compliants in the past:1yr ago
K/C/O HTN and DM since 1yr(telma 40mg,metformin 500 mg)
General examination 
On examination:
Patient is c/c/c 
Temp: 98.7F
PR- 79 bpm
RR-20cpm 
BP-160/90 mm of Hg
Spo2 -98% 
GRBS:200mg/dl
RS-B/L air entry present, NVBS
CVS- S1S2present, no murmurs heard
PA- tenderness present in epigastrium
CNS- HMF + No FND
Differential diagnosis:
? Acute on Chronic pancreatitis 
? Alcoholic gastritis 
with K/c/o HTN and DM Type 2 since 2 years
Investigations: chest x ray PA view 
hemogram:
electrolytes
serum creatinine 
LFT
Blood urea

RBS
serum amylase
lipase
nail findings 
Treatment:
1.inj.TRAMODOL 1 amp in 100 ml NS 1g IV/BD
2.IVF NS 100ml/hour 
3.tab.METFORMIN 500 mg at 8 am 
4.tab.TELMASARTAN 40 mg PO/OD at 9am
5.Inj. Zofer 4 mg IV/OD at 7 am
6.monitor vitals 4th hourly and inform sos

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