Question: A 55-year-old man, who had no previous abdominal surgery or known gallstones, was admitted to the hospital for epigastric pain, jaundice, and intermittent fevers for a week. Physical examination of an afebrile, jaundiced patient revealed a tender right hypochondrium on deep palpation. The digital rectal examination was unremarkable. Initial abnormal laboratory tests were as follows: hemoglobin,14.6 g/dL; white blood cells, 10.98 × 109/L; total bilirubin, 189 μmol/L; alkaline phosphatase, 391 U/L; alanine transaminase, 107 U/L; aspartate transaminase, 55 U/L; and serum amylase, 20 U/L.

Question: A 55-year-old man, who had no previous abdominal surgery or known gallstones, was admitted to the hospital for epigastric pain, jaundice, and intermittent fevers for a week. Physical examination of an afebrile, jaundiced patient revealed a tender right hypochondrium on deep palpation. The digital rectal examination was unremarkable. Initial abnormal laboratory tests were as follows: hemoglobin,14.6 g/dL; white blood cells, 10.98 × 109/L; total bilirubin, 189 μmol/L; alkaline phosphatase, 391 U/L; alanine transaminase, 107 U/L; aspartate transaminase, 55 U/L; and serum amylase, 20 U/L.