“Severe” – (surgical emergency) :- Abdominal rigidityIs stiffness of the stomach muscles in belly area, it’s an involuntary response to prevent pain caused by pressure on your abdomen.- Involuntary Guardingabdominal muscle spasm, caused by retroperitoneal inflammation, which cannot be willfully suppressed.- Severe Tenderness- Evidence of hypovolemic shock (eg, orthostatic blood pressure changes..)- Fallopian tube ruptures à fainting Pelvic Examination : - The uterus may be slightly enlarged and soft.- Uterine or cervical motion tenderness may suggest peritoneal inflammation.- An adnexal mass may be palpated but is usually difficult to differentiate from the ipsilateral ovary.Uterine contents may be present in the vagina, due to shedding of endometrial lining stimulated by an ectopic pregnancy.
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