ROSH Gastrointestinal Practice Exam

What is the most likely diagnosis for a woman presenting with acute right upper quadrant pain following a fatty meal?

1. Biliary colic

2. Cholangitis

3. Cholecystitis

4. Choledocholithiasis

The correct answer is: Cholecystitis

The most likely diagnosis for a woman experiencing acute right upper quadrant pain after a fatty meal is biliary colic. This condition occurs when a gallstone temporarily obstructs the cystic duct, leading to intense abdominal pain. The pain typically arises shortly after eating, especially after a meal high in fat, as fat stimulates the contraction of the gallbladder to release bile. Biliary colic pain often resolves once the obstruction is relieved, typically when the gallstone moves past the cystic duct. This condition is distinguished from other gallbladder-related issues by the fact that there is no associated fever or signs of inflammation in the walls of the gallbladder that would indicate cholecystitis. Cholecystitis, on the other hand, is characterized by prolonged obstruction and often follows biliary colic, leading to inflammation and potential complications like infection, which results in different symptoms, including fever. Cholangitis and choledocholithiasis involve complications of duct obstruction and are associated with increased severity of symptoms and additional signs like jaundice. Thus, the scenario presented aligns most closely with biliary colic due to the timing and nature of the symptoms in relation to a fatty meal.