Cholecystitis or gallstones typically present with which symptom?

• A. Severe pain in the upper right quadrant that does not radiate
• B. Pain in the upper left quadrant after fatty meals
• C. Mild mid abdominal pain unrelated to meals
• D. Severe pain in the upper right quadrant that may radiate to the shoulder, often after high-fat meals

Answer: (D)

Pain in the upper right quadrant that is severe and may radiate to the right shoulder after eating fatty meals is a classic sign of gallbladder trouble, such as cholecystitis or gallstones. The gallbladder contracts in response to a fatty meal to release bile; if a stone blocks the duct or the gallbladder is inflamed, this contraction causes intense, steady pain. The irritation of the diaphragm or nearby nerves can refer the pain to the right shoulder. This pattern differentiates it from left upper quadrant pain, mild nonspecific mid‑abdominal pain, or RUQ pain that doesn’t radiate. Nausea, vomiting, and sometimes fever may accompany the episode, and a positive Murphy’s sign on exam can support the diagnosis.