A 64 year old female presents to the emergency room with a 3 hour history of severe generalized abdominal pain. She has vomited twice and also had one episode of diarrhea.
She has noted some intermittent mild abdominal pain during the past 3 months associated with a 5-pound weight loss. On physical exam she is anxious with a blood pressure of 136/86, pulse 108, respirations 20 and normal temperature. Her abdomen is slightly distended with tenderness but no peritoneal signs.