A 48-year-old female presents with severe colicky right upper quadrant pain radiating to the right scapula following a fatty meal. Abdominal ultrasound shows gallstones, gallbladder wall thickening of 4.5 mm, and pericholecystic fluid. Murphy's sign is positive. What is the diagnosis?

Answer and explanation

Correct answer: B. Acute cholecystitis

  1. Step 1: Ultrasound findings of gallstones with gallbladder wall thickening (> 3 mm), pericholecystic fluid, and a sonographic Murphy's sign (focal tenderness under the probe) confirm acute cholecystitis.
  2. Step 2: Uncomplicated biliary colic lacks inflammatory wall thickening and systemic signs.
Answer
Acute cholecystitis.
Why not the others: 'Biliary colic' is transient pain (< 4-6 hours) without gallbladder wall edema or fever; 'Acute ascending cholangitis' involves biliary sepsis with Charcot's triad (fever, jaundice, RUQ pain); 'Acute pancreatitis' is centered in the epigastrium with elevated serum lipase/amylase.

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