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Gastro or ectopic?

A 34 year old woman presents to the Emergency Department for the second time in 4 days. Her initial presentation was for diarrhoea and vomiting, some lower abdominal pain and bloating. She had felt better whilst in the waiting room on her initial presentation. There was no real past history except for being on IVF, the last cycle being 8 weeks ago. Her last known menstrual period was 4 weeks previously. The Urine -hCG was negative. She had been sent home, with instructions to represent if symptoms worsened.

She did so, following ongoing diarrhoea and worsening abdominal pain. She now also complained of right shoulder tip pain and all movements exacerbated her pain. Her heart rate was 130 and blood pressure was 120/90.[…]

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