54-year-old hispanic male presents with intractable vomiting and upper abdominal pain.  He has a history of type 2 DM and hypertension. He was just recently discharged from the medicine service where he was hospitalized for intractable vomiting.  He denies history of early satiety or history of fried/fatty food intolerances.  On examination, the patient appears uncomfortable.  His abdomen is distended and he has midepigastric and right upper quadrant tenderness but no rebound.  His vitals signs are stable.  You are concerned about possible cholecystitis and you perform a focused GB ultrasound and note the following:

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