DDx broad at this time, likely gynecologic given ***. Cannot fully r/o ovarian torsion vs cyst vs endometriosis vs menstrual cramps vs PID vs TOA;  history and physical with low clinical suspicion to suggest life threatening etiology or surgical emergency, such as AAA, aortic dissection, acute mesenteric ischemia, peritonitis, appendicitis, complete SBO. Very low clinical suspicion of gynecological  emergency, such as sepsis, ruptured ectopic pregnancy, or fitz-hugh-curtis.  


Initial workup broad including UPT, UA, basic labs, LFTs. Cervical swabs for GC/Chlamydia and trichomonas sent. Given broad gynecological etiology still on differential, will get TVUS. Following initial workup/lab results, will consider CT abd/pelvis with contrast if no clear etiology identified. Will continue to reassess patient with serial abdominal exams while in the ER and adjust workup based on initial labs and imaging. Symptomatic control as below. Disposition pending workup.