ROSH Gastrointestinal Practice Exam

Which symptom is commonly indicative of acute cholecystitis in patients?

1. Severe left upper quadrant pain

2. Radiation of pain to the shoulder

3. Presence of melena

4. Vague abdominal discomfort

The correct answer is: Radiation of pain to the shoulder

Acute cholecystitis is characterized by inflammation of the gallbladder, often due to obstruction by gallstones. One of the hallmark symptoms of acute cholecystitis is the presence of right upper quadrant pain that can radiate to the shoulder, specifically to the right shoulder or scapula. This referred pain occurs due to irritation of the phrenic nerve, which shares the same nerve roots as the diaphragm and is activated when the gallbladder is inflamed. The other symptoms listed are less specific for acute cholecystitis. Severe left upper quadrant pain typically suggests other conditions related to the stomach or spleen rather than gallbladder issues. Melena, which refers to black, tarry stools, is indicative of upper gastrointestinal bleeding and not a symptom of acute cholecystitis. Vague abdominal discomfort can encompass a wide range of gastrointestinal issues, making it non-specific for acute cholecystitis. Thus, the symptom of pain radiating to the shoulder is particularly notable for acute cholecystitis, reflecting the underlying physiological processes involved in this condition.