QuestionSBA
QuestionChoice
Acute cholecystitis is an acute or chronic inflammation of the gallbladder, that usually occurs secondary to gallstones. It presents with right upper quadrant pain and fever. Patients are not usually jaundiced unless there is associated obstruction of the biliary tree, and nausea and vomiting are common. Generally, patients are less unwell than those with ascending cholangitis, making this option incorrect.
10008207
c
Acute cholecystitis
QuestionChoice
Acute pancreatitis can occasionally present as right upper quadrant pain, but usually the pain is epigastric and radiates to the back. It is typically associated with vomiting and signs of dehydration due to third-space fluid loss. This is not the most likely diagnosis in this case.
10008209
e
Acute pancreatitis
QuestionChoice
Ascending cholangitis is a bacterial infection of the biliary tree which presents with Charcot’s triad: right upper quadrant pain, jaundice and a fever. The patient would also display signs of sepsis, as described in this case. Therefore, this is the most likely diagnosis and the correct answer.
10008205
a
Ascending cholangitis
QuestionChoice
Biliary colic would present with colicky right upper quadrant pain which is worse after eating and no fever. Patients are generally systemically well, without the abnormal observations indicating sepsis in this case. Therefore this answer is not correct.
10008206
b
Biliary colic
QuestionChoice
A gastric ulcer can present as right upper quadrant pain but would not be associated with jaundice or signs of sepsis. Therefore this is not the correct answer.
10008208
d
Gastric ulcer
Concept
Chapter
2693
4652
Ascending cholangitis
Topic
136
Gastroenterology
14188
A 40-year-old woman presents to A&E with severe right upper quadrant pain. On examination, she is pyrexial and appears jaundiced. Her pulse is raised but her blood pressure is low. Her oxygen saturation is 96% on air.

Which of the following is the most likely diagnosis?
a