Problem: A 46-year-old, Caucasian, G0P0, woman presents with c/o acute, intense (8/10), abdominal pain, a/w nausea and vomiting. PMH significant for two laparoscopic myomectomies and primary HTN Menstrual: irregular menses a/w periods of amenorrhea altered with prolonged menstrual bleeding (20-30 days). LMP 20 days ago. FMH: non-contributory PE: alert, oriented, mildly ill appearing, uncomfortable, middle-aged women Abdomen slightly rounded, mildly distended, active bowel sounds, tympanic throughout except for RUQ liver dullness and flat in suprapubic area, moderately tender to light and deep palpation, positive R sided rebound tenderness Other WNL