Biliary colic with fever most likely represents which condition?

Biliary colic with fever most likely represents which condition?

• A. Cholelithiasis
• B. Pancreatitis
• C. Gastritis
• D. Cholecystitis

Answer: (D)

When fever accompanies biliary pain, the issue isn’t just a stone passing through the ducts—it’s inflammation of the gallbladder. A stone can block the cystic duct, leading to gallbladder distention and mucosal irritation, and bacteria can then cause an inflammatory response with fever. This pattern points to acute cholecystitis. Clinically, acute cholecystitis typically shows persistent right upper quadrant pain, fever, and often leukocytosis. On exam you may find a positive Murphy sign, and ultrasound usually reveals gallstones with gallbladder wall thickening and sometimes surrounding fluid. In contrast, simple gallstones (cholelithiasis) cause episodic pain without systemic symptoms like fever. Pancreatitis would present with upper abdominal pain radiating to the back and elevated pancreatic enzymes, not primarily fever-related RUQ pain. Gastritis causes epigastric discomfort related to meals and does not classically involve the gallbladder with fever.

When fever accompanies biliary pain, the issue isn’t just a stone passing through the ducts—it’s inflammation of the gallbladder. A stone can block the cystic duct, leading to gallbladder distention and mucosal irritation, and bacteria can then cause an inflammatory response with fever. This pattern points to acute cholecystitis.

Clinically, acute cholecystitis typically shows persistent right upper quadrant pain, fever, and often leukocytosis. On exam you may find a positive Murphy sign, and ultrasound usually reveals gallstones with gallbladder wall thickening and sometimes surrounding fluid. In contrast, simple gallstones (cholelithiasis) cause episodic pain without systemic symptoms like fever. Pancreatitis would present with upper abdominal pain radiating to the back and elevated pancreatic enzymes, not primarily fever-related RUQ pain. Gastritis causes epigastric discomfort related to meals and does not classically involve the gallbladder with fever.