consultation (flexibile sigmoidoscopy) cecal: general surgery consultation (right hemicolectomy) ectopic pregnancy abdominal and pelvic pain, bleeding if ruptured ectopic pregnancy, the patient may present with peritoneal irritation and hypovolemic shock clinical (history & physical exam) labs: complete blood count, urine pregnancy test followed with quantitative blood beta-hcg imaging: transvaginal ultrasound if patient is unstable: iv fluid resuscitation, urgent obstetrics and gynecology consultation if patient is stable: continue diagnostic workup, establish obgyn follow-up abdominal aortic aneurysm abdominal pain, flank pain, back pain, hypotension, pulsatile abdominal mass clinical (history & physical exam) imaging: ultrasound, ct angiography, mra/magnetic resonance angiography if patient is unstable: iv fluid resuscitation, urgent surgical consultation if patient is stable: admit for observation aortic dissection abdominal pain (sudden onset of epigastric or back pain), hypertension, new aortic murmur clinical (history & physical exam) imaging: chest x-ray (showing widened mediastinum), ct angiography, mra, transthoracic echocardiogram/tte, transesophageal echocardiogram/tee iv fluid resuscitation blood transfusion as needed (obtain type and cross) medications: reduce blood pressure (sodium nitroprusside plus beta blocker or calcium channel blocker) surgery consultation liver injury after trauma (blunt or penetrating), abdominal pain (ruq), right rib pain, right flank pain, right shoulder pain clinical (history & physical exam) imaging: fast examination, ct of abdomen and pelvis diagnostic peritoneal aspiration and lavage resuscitation (advanced trauma life support) with iv fluids (crystalloid) and blood transfusion if patient is unstable: general or trauma surgery consultation with subsequent exploratory laparotomy splenic injury after trauma (blunt or penetrating), abdominal pain (luq), left rib pain, left flank pain clinical (history & physical exam) imaging: fast examination, ct of abdomen and pelvis diagnostic peritoneal aspiration and lavage resuscitation (advanced trauma life support) with iv fluids (crystalloid) and blood transfusion if patient is unstable: general or trauma surgery consultation with subsequent exploratory laparotomy and possible splenectomy if patient is stable: medical management, consultation of interventional radiology for possible arterial embolization epidemiology abdominal pain is the reason about 3% of adults see their family physician. rates of emergency department (ed) visits in the united states for abdominal pain increased 18% from 2006 through to 2011. this was the largest increase out of 20 common conditions seen in the ed. the rate of ed use for nausea and vomiting also increased 18%.