A 57 year old woman presents with nausea and worsening pain in the right upper quadrant for 1 day. The pain was sharp and colicky, and radiated to the right shoulder.

Her medical history is significant for gastroesophageal reflux disease for 5 years, and chronic back pain for 2 years, for which she is on omeprazole and ibuprofen respectively. Her family history is unremarkable, she only drinks socially, and does not smoke.

Serial ECGs are found to be normal. A complete blood count is significant for a leukocytosis of 13,000/mm3, with 70% neutrophils and 26% lymphcytes.