Your patient complains of abdominal pain that occurs mostly at night or after eating fatty foods. You should suspect ____________.

• A. Kidney stones
• B. Appendicitis
• C. Cholecystitis
• D. A hernia

Answer: (C)

Pain that comes after fatty meals points to gallbladder disease, because fatty foods trigger the release of cholecystokinin, prompting the gallbladder to contract to release bile. If the gallbladder is inflamed or obstructed, that contraction produces the characteristic right upper-quadrant pain, which can be worsened after meals and may occur at night. This pattern makes gallbladder inflammation (cholecystitis) the most likely diagnosis here. The other conditions don’t fit the meal-related pattern: kidney stones typically cause sudden, severe flank or groin pain not specifically tied to meals; appendicitis starts around the navel and migrates to the lower right abdomen and isn’t meal-related; a hernia causes localized bulging or discomfort often with activity, not tied to fatty foods or nocturnal timing.