60% are surgical
Acute onset associated with catastrophe
Med list is important
Abdominal exam generally unhelpful/difficult to localize pain
Misc 25%
MI, dissection, mesenteric ischemia
Biliary disease - 21%
Unknown - 20%
Obstruction - 12%
previous surgery adhesions, internal/external hernia, malignancy
sigmoid/cecal volvulus - persistent pain, can be subacute, nausea and vomiting, may not have fever
Perforated viscus - 7%
NSAIDs
Diverticular - 10%
Appendicitis - 5%
60% perforation in OR, lacking rebound/guarding
Renal colic - 4%
MI, dissection, mesenteric ischemia
previous surgery adhesions, internal/external hernia, malignancy
sigmoid/cecal volvulus - persistent pain, can be subacute, nausea and vomiting, may not have fever
NSAIDs
60% perforation in OR, lacking rebound/guarding
Abdominal pain 
Nausea and vomiting 
Nausea and vomiting
Diffuse abdominal pain
Vaginal bleeding 
Chest pain 
Abdominal distention
Fever and rash