Patient states she was feeling fine until around 10pm when she suddenly developed abdominal pain and “bloating”. She describes the pain as generalized, but mentions that it feels more severe around the edges of her abdomen, in the suprapubic area, and at both costal margins. The upper abdominal pain is most severe in the midline and is worse when she breathes in or presses on it.

“You need to have a rectal exam” you explain to one of your patients. He’s a 47-year-old with chronic back pain who is in the ED for an exacerbation of his pain accompanied by many of the associated accoutrements, such as sciatica, numbness and trouble urinating.