A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. What is the next step in management?

The presentation of boring epigastric pain that radiates to the back and is relieved by sitting forward is highly suggestive of acute pancreatitis, especially in a patient with a history of alcohol abuse, which is a common cause of this condition.

In cases of suspected acute pancreatitis, the immediate management involves confirming the diagnosis and initiating supportive care. Supportive care for acute pancreatitis typically includes intravenous fluids, electrolyte management, and pain control, as well as monitoring for potential complications.

While imaging studies, such as an abdominal ultrasound or CT scan, can be helpful in diagnosing pancreatitis and evaluating the severity or complications, they are not always necessary for the initial management if the clinical suspicion is high and the patient's presentation aligns with classic symptoms. Therefore, starting supportive care based on the clinical picture is the most appropriate next step in this scenario.

Initiating treatment for peptic ulcer disease or performing an abdominal ultrasound may address different diagnoses, but do not target the immediate management of suspected acute pancreatitis.