A 60 year old male presents to ED with complaint of abdominal pain worsening for last few weeks, now limiting his daily activities. His HR 80, BP 130/70, afebrile. RR 18. His current pain is 5/10, On abdominal exam he is moderately tender in central abdomen.
Bedside USG is performed and following image is saved. 
Questions:
- What structure can be seen ?
- What will be next step in management of this patient?