A 43-year-old woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There was multiple vomiting without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?

Answer options

1. Right-sided renal colic
2. Acute cholecystitis
3. Acute appendicitis
4. Acute bowel obstruction
5. Perforative ulcer

Explanation

A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple vomitings without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?The correct answer is Acute cholecystitis but in Krok base gives perforative ulcer. However, in the question asked in 2004, the answer was stated as Acute