Question: A 52-year-old woman without any significant medical history presented to the emergency department with a 2-day history of poor appetite, chills, and abdominal pain. The patient was alert at the emergency room. The initial temperature was 98.6°F (37°C), pulse 132 beats/min, respiratory rate 18 breaths/min, and blood pressure 97/57 mm Hg. The patient exhibited scleral icterus and yellowish skin color. Physical examination revealed a distended abdomen with muscle guarding and right upper quadrant tenderness.
