Acute cholecystitis vs Common bile duct obstruction patterns
How to tell Acute cholecystitis and Common bile duct obstruction patterns apart when a board question makes them look alike.
Cholecystitis is inflamed gallbladder with Murphy sign; choledocholithiasis is CBD stone; cholangitis is infected CBD obstruction with fever and jaundice.
Side by side
Cystic duct obstruction with gallbladder inflammation, right upper quadrant pain, fever, leukocytosis, and positive Murphy sign.
Common bile duct stone causes jaundice and duct dilation; infection of obstructed bile ducts causes fever, jaundice, RUQ pain, hypotension, or confusion.
Gallstone obstruction of the cystic duct traps bile and inflames the gallbladder.
Common bile duct obstruction blocks bile drainage; bacterial infection under pressure produces ascending cholangitis.
Murphy sign, gallbladder wall thickening, pericholecystic fluid, and cystic duct obstruction support cholecystitis.
Dilated common bile duct, jaundice, elevated direct bilirubin/alkaline phosphatase, and Charcot triad support CBD obstruction or cholangitis.
The trap
Right upper quadrant pain overlaps, so localize the stone to cystic duct versus common bile duct and ask whether infection is systemic.
The repair move
For biliary disease, localize the obstruction first, then decide whether infection has turned obstruction into cholangitis.
Try a free question
CoreA patient has postprandial right upper quadrant pain, fever, leukocytosis, and a positive Murphy sign. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Acute cholecystitis. Acute cholecystitis is gallbladder inflammation, usually from cystic duct obstruction, with fever and Murphy sign.
Why the other choices are tempting
- B. Ascending cholangitis adds infected common bile duct obstruction with Charcot triad.
- C. Choledocholithiasis is common bile duct stone obstruction and may cause jaundice without infection.
- D. Acute pancreatitis causes epigastric pain radiating to the back and elevated lipase.
- E. Hepatitis A causes acute viral hepatitis symptoms and transaminase elevation.
Flashcards
Tap a card to flip it.
What sign points to acute cholecystitis?
A positive Murphy sign with RUQ pain and fever points to gallbladder inflammation.
What duct is obstructed in classic acute cholecystitis?
The cystic duct is obstructed, trapping bile in the gallbladder.
Quick answers
What is the fastest way to tell Acute cholecystitis from Common bile duct obstruction patterns?
Cholecystitis is inflamed gallbladder with Murphy sign; choledocholithiasis is CBD stone; cholangitis is infected CBD obstruction with fever and jaundice.
What is the key clue for Acute cholecystitis?
Cystic duct obstruction with gallbladder inflammation, right upper quadrant pain, fever, leukocytosis, and positive Murphy sign.
What is the key clue for Common bile duct obstruction patterns?
Common bile duct stone causes jaundice and duct dilation; infection of obstructed bile ducts causes fever, jaundice, RUQ pain, hypotension, or confusion.
What is the common trap with Acute cholecystitis vs Common bile duct obstruction patterns?
Right upper quadrant pain overlaps, so localize the stone to cystic duct versus common bile duct and ask whether infection is systemic.