<prompt> A 53 year old male who is a heavy alcoholic presents with 12 hour history of sharp central abdominal pain and vomiting. He prefers to sit up rather than lying fiat as pain increases on lying down. OE he has mild jaundice. Temp - 38. 3deg C. Pulse 132min BP 11882 mm Hg. There is periumbilical discoloration and maximum tenderness in epigastrium. DiagnosisAcute pancreatitisPyelonephritisAcute viral hepatitisPerforated duodenal ulcer  <response>: Ans. a Acute pancreatitisRef: Sabiston page 152520th edition History of pain reduced on sitting with leaning forward is typical pancreatic pain. Periumbilical discoloration Cullens signAll these favor more of acute pancreatitis 