Problem: You are seeing a 47-year-old patient with acute abdominal pain, nausea, and vomiting. The patient has a medical history of hypertension, and had a hysterectomy 8 months ago for fibroids. On exam, you note abdominal distention, tachycardia, and dry mucous membranes. An abdominal X-ray shows dilated loops of bowel with air-fluid levels. What is your suspected diagnosis and what is the next step in management? A. Gastroenteritis, antibiotics as outpatient B. Appendicitis, consult surgeon C. Acute cholecystitis, low fat diet and bowel rest D. Small bowel obstruction, admission to hospital and referral for surgery