A 60-year-old woman with known gallstones presents with fever, right upper quadrant pain, and jaundice of 24 hours duration. She is alert, blood pressure is 118/76 mmHg, and pulse is 96/min. The most likely diagnosis is:
- A Acute calculous cholecystitis
- B Gallbladder empyema
- C Mirizzi syndrome
- D Acute ascending cholangitis ✓
Explanation
Fever, right upper quadrant pain, and jaundice together constitute Charcot's triad, the classical presentation of acute ascending cholangitis from an impacted common bile duct stone. The presence of jaundice is the discriminating feature against acute cholecystitis and empyema, where the inflammation remains confined to the gallbladder and serum bilirubin is normal or only mildly raised. Mirizzi syndrome causes obstructive jaundice from extrinsic compression of the common hepatic duct but does not produce the acute septic picture of fever and rigors. Shock with altered sensorium would upgrade this to Reynolds' pentad, indicating suppurative cholangitis.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.