Rosh Internal Medicine Boost Practice Exam

What is the most likely diagnosis for a patient presenting with fever, chills, and jaundice with findings of dilated common bile duct?

1. Acute cholangitis

2. Acute cholecystitis

3. Acute hepatitis

4. Cholelithiasis

The correct answer is: Acute cholangitis

In a patient presenting with fever, chills, and jaundice alongside imaging or physical examination findings of a dilated common bile duct, the clinical picture strongly indicates acute cholangitis. This condition arises from an infection of the bile duct, often due to an obstruction, such as from a gallstone. The classic triad of symptoms associated with acute cholangitis includes jaundice, fever, and right upper quadrant pain (often referred to as Charcot's triad). The fever and chills suggest an infectious process, which aligns with the diagnosis of cholangitis due to the presence of bacteria proliferating within the bile duct system obstructed by a stone or other causes. The dilation of the common bile duct is indicative of increased pressure in the biliary system, commonly resulting from obstruction, which can lead to infection as bile becomes stagnant. In acute cholangitis, the obstruction allows bacteria from the duodenum to ascend into the biliary tract, resulting in an infection that presents with systemic symptoms such as fever and chills. Acute cholecystitis, while it involves similar symptoms, typically presents with right upper quadrant pain and gallbladder inflammation but does not necessarily cause jaundice or dilation of the common bile duct unless there’s a complication