An office manager in a design studio in London, who does not have much of a past medical history. For the last 3 days, he has been experiencing sharp stabbing and burning pain in his right side,just under the rib cage. He does not remember injuring himself and self treatment with pain killer (paracetamol and ibuprofen) and with antacids (gaviscon and ranitidine) have no effects. The pain is bad enough to wake him at night.

His record revels several levels of anxiety, sometimes treated with benzodiazepins or latterly serotonin type antidepressants, but none of them have long lasting effect.

a) What likely be explanations are there for his pain

b) How might the illness develop over the next few dsys

c) what traleatments are available

d) what further investigations might you consider.