Introduction Differential based on location Epigastric Myocardial InfarctPerforated UlcerAcute pancreatitis RUQ VARIABLE LOCATION LUQ Billiary ColicAcute cholecystitisAcute hepatitisAcute cholangitis Mesenteric ThrombosisStrangulated bowelSmall Bowel Obstruction - RLQ SUPRAPUBIC LLQ AppendicitisAcute Salpingitis Ureteral ColicPIDEctopic Pregnancy Ruptured aneurysmDiverticulits Presentation Symptoms abrupt, excruciating pain, rapid onset of severe constant pain, gradual steady pain, intermitten, colicky pain with free intervals Physical exam guiac Evaluation Labs: CBC Chem 7 PT/PTT amylase rule out ectopic pregnancy with B-HCG Imaging AXR and CXR R/O cholecystitis if RUQ pain with ultrasound/HIDA scan pericentesis if ascites Treatment Based on diagnosis