Ms. A. presents with a complaint of abdominal pain in her low to mid-abdomen for 2 weeks that radiates to her lower back. Ms. A describes the pain as gnawing and intense. It is not influenced by meals or activity. She has never had anything like this before. She has had no surgery in the past.

Additional history reveals that Ms. A. is a 67 year old retired school teacher who has had Type 2 diabetes mellitus for the past 9 years and hypertension for 20 years. She has taken metformin for her diabetes for the past 3 years and says her sugar is in good control. She has been prescribed various agents for her blood pressure and is currently taking a combination of amlodipine and benazepril, but does not like it because it makes her constipated. She is married and monogamous. She has had three children who are now adults and are in good health. Since retiring from teaching she and her husband (a retired infectious disease specialist from a local medical college) have liked to travel to exotic locations. Just this summer they spent 3 weeks on an African tour.