A 60 year old man presents with a one month history of vague pain in the epigastric area. A week ago he noticed that his urine was darker in color. Then four days ago he had the onset of right upper quadrant pain, high fever with chills, and vomiting. On physical exam, he was mildly icteric with temperature of 39 and blood pressure of 140/70. He appeared acutely ill and toxic. On abdominal exam there was diffuse tenderness in the right upper quadrant with mild hepatomegaly.