T. O. is a 44-year-old female patient who presents for evaluation of sudden, severe upper abdominal pain. She is

clear about the onset, which was profound and occurred approximately one hour ago. She denies that the onset had any relationship to food or eating, and she denies nausea or vomiting. On examination, she is lying on her right side with her hips and knees flexed to draw her knees to her chest. Vital signs are stable, but examination reveals involuntary guarding. The abdomen is painful and tympanic to percussion in all quadrants. CBC reveals a white blood cell count of 15,600/µL. The AGACNP suspects:

A. Dissecting aortic aneurysm

B. Acute pancreatitis

C. Perforated peptic ulcer

D. Mallory-Weiss tear

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