Here is the paraphrased version of question 123 with five options, the correct answer, and an explanation:
---
### **Specialty: Gastroenterology**
**Question:**
A 33-year-old woman presents with right upper quadrant pain and jaundice. On examination, she appears unwell with abdominal tenderness but no guarding. Laboratory results show elevated total bilirubin and alkaline phosphatase, as well as an increased white blood cell count. An ultrasound of the abdomen reveals multiple gallstones and a dilated common bile duct measuring 10 mm. What is the most likely diagnosis?
**Options:**
A) Acute pancreatitis
B) Acute cholecystitis
C) Choledocholithiasis
D) Ascending cholangitis
E) Hepatitis
**Correct Answer:** D) Ascending cholangitis
**Explanation:** The combination of right upper quadrant pain, jaundice, and laboratory findings of elevated bilirubin and alkaline phosphatase, along with a dilated common bile duct on ultrasound, strongly suggests **ascending cholangitis**. This condition typically occurs due to a bacterial infection following bile duct obstruction, often caused by a gallstone. The presence of a dilated bile duct without pericholecystic fluid makes ascending cholangitis more likely than acute cholecystitis. Ascending cholangitis is a serious and potentially life-threatening condition that requires urgent medical attention.
---
You can now copy this **Gastroenterology** question directly. Let me know if you need any further assistance!