• Patient with sickle cell disease presenting with fever, RUQ pain, mild scleral icterus and positive Murphy sign (specific for acute cholecystitis on NBME exams) with an ultrasound showing cholelithiasis and pericholecystic fluid, most consistent with acute cholecystitis
• Key idea: Acute cholecystitis classically does NOT lead to jaundice or hyperbilirubinemia, but this patient has another reason to have jaundice because sickle cell disease –> chronic hemolysis –> unconjugated hyperbilirubinemia
• Risk factors for cholesterol gallstones: Female, Fat, Forty, Fertile
• Risk factors for bilirubin gallstones –> Chronic hemolysis
• Cholangitis –> Negative Murphy sign, signs of cholestasis (alkaline phosphatase > ALT/AST), dilated common bile duct

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DDx with acute pancreatitis = Acute pancreatitis (Choice A) presents with epigastric abdominal pain, nausea, and emesis, often in patients with a history of gallstones, alcoholism, trauma, hypertriglyceridemia, or hypercalcemia. It can be complicated by necrosis, hemorrhage, abscess, or the formation of pseudocysts. Labs: increased lipase.