A 56 year old male who has drunk 5 beers/day for 35 years now presents with abdominal pain. The pain is epigastric and goes through to the back. He has mild nausea but no vomiting. He has lost 15 pounds over the last year unintentionally. On examination he is a thin male with scaphoid abdomen. He has tenderness in the upper abdomen. The gallbladder is not palpable.