A 40-year-old female with right upper quadrant pain radiating to the back and low-grade fever has urinary bilirubin and elevated alkaline phosphatase. The most likely diagnosis is which of the following?

• A. Cholecystitis
• B. Viral hepatitis
• C. Gilbert’s syndrome
• D. Dubin-Johnson syndrome

Answer: (A)

The key idea is a biliary inflammatory process producing a cholestatic pattern. Right upper quadrant pain that radiates to the back, plus fever, fits an inflammatory/gallbladder issue like acute cholecystitis. The laboratory clue of elevated alkaline phosphatase points to cholestasis—bile flow obstruction or gallbladder/extrahepatic biliary tract inflammation. Seeing bilirubin in the urine supports conjugated bilirubin in the bloodstream due to cholestasis, rather than a hepatocellular injury pattern.

Viral hepatitis would more typically show a predominant rise in transaminases (ALT/AST) with a different pattern of bilirubin handling and less pronounced alkaline phosphatase elevation. Gilbert’s syndrome and Dubin-Johnson syndrome cause hyperbilirubinemia without painful symptoms or fever and do not explain the elevated alkaline phosphatase or acute inflammatory presentation.

So, the presentation best fits acute cholecystitis.