40 year old male with ? acute pancreatitis

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I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history,  clinical findings, investigations and come up with diagnosis and treatment plan.

 A 40 year old male came to the casuality with chief complaints of abdominal pain since morning and vomitings since evening 5pm.

History of present illness:

Patient was apparently asymptomatic 3 years back. Then developed abdominal pain and vomitings and was diagnosed as acute interstitial pancreatitis. For which, he received treatment in the hospital (KIMS) for 1 week. 

Patient had similar complaints of abdominal pain, vomitings, constipation 1 year back. 

Pain abdomen:

Site - epigastric region,

pricking type, non radiating,

relieved on bending forward position.

H/O vomitings: 10 episodes, non projectile with food particles as content.

CVS, CNS, RS - normal

CT scan: interstitial edematous pancreatitis, no evidence of necrosis, mild ascites, CTSS - 6/10

Again in January, patient came with complaints of pain abdomen (site: umbilical region) radiating to back and was diagnosed as acute on chronic pancreatitis secondary to alcohol consumption.

Now, he came with complaints of pain abdomen since morning, which is squeezing type, non progressive, aggravated on food intake.

H/o vomitings - 5 to 6 episodes since evening 5pm. 

C/o decreased urine output

No c/o chest pain, palpitations, syncopal attacks, sob, orthopnea, PND.

Past history:

Not a known case of HTN, DM, CAD, ASTHMA, TB, CVA, Thyroid disorders.

No H/o surgeries and blood transfusions in the past.

Personal history:

He takes mixed diet.

Appetite - normal

Sleep - Adequate

Bowel habits - not passing stools since morning.

Decreased urine output

Addictions:

- Alcoholic since 7 years: consumes 180 - 360 ml/day

Last binge - yesterday

No known drug allergies.

Family history:

No significant family history.

General examination:

Patient is conscious, coherent, co-operative and oriented to time, place and person.

No pallor, icterus, cyanosis, clubbing, koilonychia, generalized lymphadenopathy and edema

Vitals:

Temp - 98.9 °F

PR - 100 BPM

BP - 150/90 mm Hg

RR - 24cpm

GRBS - 124 mg/dl 

Systemic examination:

Per abdomen:

Soft

Tenderness + : in epigastric region

No palpable masses

Hernial orifices - normal

Bowel sounds - heard

CVS:

S1, S2 heard

No thrills and Murmurs

Respiratory system:

BAE +

NVBS heard

Trachea - Central

No adventitious sounds

CNS:

Speech - normal

No signs of meningeal irritation

Motor and sensory system - normal

Cranial nerves - intact

Reflexes - present

Provisional diagnosis:

Acute on chronic pancreatitis

Investigations:

Chest X ray PA view

X- ray Erect abdomen:

Treatment given:

1. Nil per oral till further orders.

2. IV fluids - NS & RL @ 125ml/hr

3. Inj. TRAMADOL 50 mg in 100ml NS IV/TID

4. Inj. ZOFER 4mg IV/TID

5. Inj. PAN 40mg IV/OD

6. BP, PR, Temp, RR monitoring 4th hourly

7. Abdominal girth monitoring 2nd hourly