Choledocholithiasis and bile stasis

A 35-year-old woman presents with worsening right upper quadrant pain for two days. For the past 3 months she’s had a similar pain 1-2 hours after meals, but now the pain is more severe and constant. She has also felt feverish and complains of clay-colored stools, dark urine, and a yellowish skin color. What is the most likely diagnosis?

1.Acute cholecystitis
2.Ascending cholangitis
3.Biliary colic

Correct answer
Ascending cholangitis
correct answer: B

Ascending cholangitis is thought to be an ascending bacterial infection related to (D) choledocholithiasis and bile stasis. Charcot’s triad of RUQ pain, fever, and jaundice are typical of ascending cholangitis. Reynold’s pentad includes hypotension and altered mental status in addition to Charcot’s triad.
(A) The presence of clay-colored stools, dark urine, and jaundice suggests that the blockage is distal to the cystic duct (e.g. in the common bile duct), making acute cholecystitis incorrect.
Biliary colic does not present with fever, jaundice, dark urine, and clay-colored stools.
Uncomplicated choledocholithiasis does not present with fever and intense pain.
Gallstones in the common bile duct can cause pancreatitis, but pancreatitis is unlikely to be the primary illness in this case.