A 65 year old female with a past history of osteoarthritis and diabetes mellitus presents to the ER with a history of hematemesis twice and near syncope. She also reports three episodes of loose black stools today. In the emergency room, she has a heart rate of 100, BP of 100/50, and a positive tilt test. Her respiratory rate is 22. On abdominal exam her abdomen is distended but not tender.