Abdominal flat plate and upright for bowel obstruction, ileus, free air, abnormal calcification. Ultrasonography to look for peritoneal fluid. ECG for acute MI, ischemia, or arrhythmias. Paracentesis may be important with fluid in the abdomen or in evaluation of abdominal trauma. Pregnancy test on all reproductive-age females unless status post hysterectomy.
Sexual history is often unreliable in the emergency setting.
Initial Treatment Decide whether to admit and observe, discharge, operate. Serial exams may clarify the diagnosis. Keep NPO until diagnosis is clear. Decide on expected fluid losses and current level of hydration. NG tube for vomiting, bleeding. or obstruction.