This is a 37y female with no known chronic illnesses presents with one month history of epigastric pain associated with post prandial vomiting even if it's liquids shortly after drinking or eating. Has nausea and vomits everyday. The vomit is sometimes undigested food or brownish in colour. Has frequent regurgitation as well. Loss of appetite as well. Last passed stool a week ago. Still passing flatus. She says she hasn't passed stool because she hasn't been able to eat. She came dehydrated with tachycardia and bp86/65. No past medical or surgical history. Reported use of traditional meds a week ago. Doesn't drink alcohol neither smokes. Abdomen is not distended and it's soft with marked tenderness on the epigastric region and suprapubic region. No mass palpable. ABG: ph7.6 pco2 27.8 hco3 act 26.9 hco3 std 29.9 hb12 na144 k+2.78 cl98