A 45 year old male presents to your rural emergency department with 48 hours of progressive abdominal pain. The pain initially began as epigastric pain but has moved to the right lower quadrant over the last 12 hours, along with nausea and vomiting. There is no diarrhea, dysuria or flank pain. The patient has not had prior abdominal surgeries, and past medical history is unremarkable. The patient is partially curled up on the table. The abdomen is rigid without any organomegaly. Point of maximal tenderness is in the right lower quadrant.