ROSH Gastrointestinal Practice Exam

In a patient with right upper quadrant pain and tenderness, which diagnosis is most likely if fever is absent and an ultrasound is performed?

1. Cholangitis

2. Cholecystitis

3. Choledocholithiasis

4. Symptomatic cholelithiasis

The correct answer is: Symptomatic cholelithiasis

In the context of a patient presenting with right upper quadrant pain and tenderness, the absence of fever plays a significant role in narrowing down potential diagnoses. Symptomatic cholelithiasis refers to the presence of gallstones that cause episodes of biliary colic, often leading to pain but not necessarily associated with fever or acute inflammation. When an ultrasound is performed, it may reveal gallstones without any signs of gallbladder inflammation or complications. Fever is typically a hallmark of conditions like cholecystitis, where the gallbladder is inflamed, or cholangitis, characterized by infection of the bile duct leading to systemic symptoms including fever. In contrast, choledocholithiasis can also cause symptoms due to bile duct obstruction, but fever often indicates a more severe complication. Given that this scenario specifically mentions the absence of fever, it aligns well with the diagnosis of symptomatic cholelithiasis, where the patient experiences pain due to the presence of gallstones but has not developed any associated inflammatory signs that would elevate suspicion for other conditions. Thus, in the absence of fever and based on ultrasound findings, symptomatic cholelithiasis is the most appropriate diagnosis.