A patient develops severe right upper quadrant pain after a fatty meal with radiation to the right scapula and nausea. Which condition is most likely?

• A. Gastritis
• B. Pancreatitis
• C. Cholecystitis
• D. Appendicitis

Answer: (C)

Focus on a gallbladder problem. When pain begins in the right upper quadrant after a fatty meal, and then radiates to the right shoulder/scapula with nausea, it points to inflammation of the gallbladder—cholecystitis. A fatty meal prompts the gallbladder to contract; if it’s inflamed, that contraction causes significant pain. The radiation to the right scapula can occur because the gallbladder shares nerve pathways with the diaphragm, sending pain upward toward the shoulder region. A common sign you might hear about is a positive Murphy sign, though not always present.

In contrast, pancreatitis typically causes epigastric pain that often radiates to the back and isn’t specifically tied to fatty meals or to the scapular region. Gastritis presents with epigastric burning and discomfort rather than localized RUQ pain radiating to the shoulder. Appendicitis starts around the umbilicus and migrates to the right lower quadrant, not after meals and not in the RUQ with scapular radiation.