34. A 42-year-old male presents with severe epigastric pain radiating to the back, nausea, vomiting, and a rigid abdomen that has developed over the past 12
hours. His vital signs are BP 112/68 mmHg, HR 118/min, RR 22/min, SpO2 96% on room air, and temperature 100.2°F (37.9°C). His medical history includes
cholelithiasis and heavy alcohol use. What is the most likely cause of this patient's clinical presentation?
Peptic ulcer disease
Gastroenteritis
Cholelithiasis
Pancreatitis
Cholecystitis