Abdominal Sounds

50 year old man with recent onset jaundice.

Patient Chart

A 50 year old man is admitted to the hospital with a history of colon cancer and recent onset of jaundice.

Physical Exam

Abdominal tenderness in right upper quadrant. Normal BP (120/80). Jaundice is noted in sclera. Abdomen is distended. Swollen ankles.

Direct bilirubin is elevated.

What is the diagnosis?