Review Question - QID 214897

A 27-year-old woman presents with 10 hours of progressive abdominal pain. She states that the pain localizes to her right abdomen and began shortly after dinner. She also reports nausea, vomiting, subjective fevers, and dark urine. Her temperature is 101.8°F (38.7°C), blood pressure is 118/68 mmHg, pulse is 110/min, and respirations are 19/min. Physical exam discloses abdominal tenderness to palpation in the right upper quadrant, scleral icterus, and diffuse jaundice. Laboratory workup includes the following:

Hemoglobin: 8.5 g/dL
Leukocyte count: 14,000 /mm^3
Platelet count: 390,000 /mm^3
Mean corpuscular hemoglobin concentration: 39%
Mean corpuscular volume: 85 µm^3
Reticulocyte count: 4.1%
Lactate dehydrogenase: 350 U/L
Haptoglobin: 18 mg/dL
Direct coombs: Negative

Serum:
Aspartate aminotransferase (AST): 79 U/L
Alanine aminotransferase (ALT): 83 U/L
Total bilirubin: 3.5 mg/dL
Direct bilirubin: 0.8 mg/dL
Alkaline phosphatase: 160 U/L

A right upper quadrant ultrasound reveals gallbladder wall thickening consistent with cholecystitis. She is taken to the operating room for an urgent cholecystectomy. Which of the following is her most likely underlying diagnosis?