A 45-year-old female presents with severe colicky right upper quadrant pain radiating to the right scapula, triggered after eating a high-fat meal. Abdominal ultrasound demonstrates acoustic shadowing from multiple mobile stones in the gallbladder, with a normal common bile duct and no gallbladder wall thickening. What is the diagnosis?

Answer and explanation

Correct answer: C. Symptomatic cholelithiasis (biliary colic)

  1. Step 1: Evaluate ultrasound and symptoms: Presence of mobile gallstones with postprandial episodic pain and absence of inflammatory wall thickening () or pericholecystic fluid defines symptomatic cholelithiasis (biliary colic).
  2. Step 2: Distinguish from acute cholecystitis: Acute cholecystitis requires persistent pain, fever, leukocytosis, gallbladder wall thickening, and sonographic Murphy's sign.
  3. Step 3: Confirm diagnosis: Symptomatic cholelithiasis.
Answer
Symptomatic cholelithiasis (biliary colic).
Why not the others: 'Acute acalculous cholecystitis' occurs in critically ill patients without gallstones; 'Ascending cholangitis' presents with Charcot's triad (fever, jaundice, RUQ pain); 'Chronic pancreatitis' shows pancreatic calcifications and ductal dilation.

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