Your 44-year-old female patient complains of right upper quadrant pain. Her skin and sclera are yellow, and she has hyperbilirubinemia and elevated liver enzymes. The clinician should suspect:
A. Acute pancreatitis
B. Biliary duct obstruction
C. Acute hepatitis
D. Atypical appendicitis
ANS: B
In cholecystitis, acute colicky pain is localized in the RUQ and is often accompanied by nausea and vomiting. Murphy's sign is frequently present. Fever is low grade, and the increase in neutrophilic leukocytes in the blood is slight. Acute cholecystitis improves in 2 to 3 days and resolves within a week; however, recurrences are common. If acute cholecystitis is accompanied by jaundice and cholestasis (arrest of bile excretion), suspect common duct obstruction.
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