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Chief Compliant: The patient is a 50 year old white male with obesity who complains of right upper quadrant pain for 6 hours.

History of the Present Illness: Biliary colic (constant right upper quadrant pain, 30-90 minutes after meals, lasting several hours). Radiation to epigastrium, scapula or back; nausea, vomiting, anorexia, low-grade fever; fatty food intolerance, dark urine, clay colored stools; bloating, jaundice, early satiety, flatulence, obesity.

Previous epigastric pain, gallstones, alcohol.

Past Medical History: Fasting, weight loss, hyperalimentation, estrogen, pregnancy, diabetes, sickle cell anemia, hereditary spherocytosis. Prior Testing: Ultrasounds, HIDA scans, endoscopies.

Causes of Cholesterol Stones: Hereditary, pregnancy, exogenous steroids, diabetes, Crohn's disease; rapid weight loss, hyperalimentation.

Causes of Pigment Stones: Asians with biliary parasites, sickle cell anemia, hereditary spherocytosis, cirrhosis.

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