24th July 2023

A 52-year-old man presents to A&E with a 1-day history of abdominal pain

A 52-year-old man presents to A&E with a 1-day history of abdominal pain, which has increased in severity over the past few hours. He has previously had pains like this – generally after a heavy meal – but it usually settles after an “hour or so” and has never been this severe.

He feels nauseous and has vomited twice. On examination, he is of normal colour but visibly sweaty. He is tender in his right upper quadrant. Observations: HR 122 bpm, RR 20/min, SpO2 98% on air, BP 102/62 mmHg, and T 38.1 oC.

Which of the following features from this history most supports a diagnosis of cholecystitis over biliary colic?

Select the SINGLE most appropriate option from the list below. Select ONE option only.