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Fever, jaundice and right upper quadrant pain
Surgery · exam-style practice question with explanation
A 58-year-old man presents with fever with rigors, jaundice and right upper quadrant pain. What is the most likely diagnosis?
- A. Acute cholecystitis
- B. Acute pancreatitis
- C. Ascending cholangitis
- D. Hepatocellular carcinoma
Show the answer and explanation
Answer: C. Ascending cholangitis
Fever, jaundice and right upper quadrant pain form Charcot's triad, the classic picture of ascending cholangitis: infection of an obstructed common bile duct, usually from a stone. Add hypotension and confusion and it becomes Reynolds' pentad. Treatment is fluids, antibiotics and urgent biliary drainage.
Key point: Charcot's triad = fever + jaundice + RUQ pain = ascending cholangitis.
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