A 45 year old female presents with pain localized to the right upper quadrant, nausea, vomiting, a low-grade fever and tachycardia. What is the most likely cause?

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Pain confined to the right upper quadrant with nausea, vomiting, a low-grade fever, and a fast heart rate in a middle-aged woman points to inflammation of the gallbladder, usually due to gallstones blocking the cystic duct. This obstruction leads to bile buildup, gallbladder wall inflammation, and local pain that is typical of cholecystitis. The fever and tachycardia reflect the body’s inflammatory response.

Pancreatitis tends to present with pain in the upper abdomen that often radiates to the back and is commonly associated with very high pancreatic enzyme levels and risk factors like alcohol use, making it less likely given the localized RUQ pain described. Appendicitis usually starts around the periumbilical area and then localizes to the right lower quadrant, not the RUQ. Peritonitis would cause diffuse abdominal pain with guarding and rebound tenderness due to widespread irritation of the peritoneum, rather than localized RUQ pain.

So the pattern of RUQ pain with systemic signs most consistently fits gallbladder inflammation from gallstone obstruction. Imaging with RUQ ultrasound is typically used to confirm cholecystitis, and management involves supportive care and often cholecystectomy.