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【单选题】
女，45岁，既往有胆石症及冠心病史。昨日饮酒及进油腻饮食后出现剧烈腹痛并向腰背放射，伴发热和恶心、呕吐。查体：Bp70/40mmHg，p120次/分，巩膜轻度、皮肤湿冷。腹壁稍紧张，上腹有明显压痛，移动性浊音阳性血清淀粉酶64单位(苏氏法)，血钙1.5mmol/L，血清正铁血白蛋白阳性。诊断应首先考虑（ ）A.
消化性溃疡合并急性穿孔
B.
急性阑尾炎穿孔
C.
急性出血坏死型胰腺炎
D.
慢性胆囊炎急性发作
E.
急性心肌梗死
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