During an acute episode of cholecystitis, where is the pain most likely located and radiating?

• A. Right lower quadrant, radiating to the back
• B. Right upper quadrant, radiating to the left scapula and shoulder
• C. Right lower quadrant, radiating to the umbilicus
• D. Right upper quadrant, radiating to the right scapula and shoulder

Answer: (D)

Pain in the right upper quadrant that radiates to the right scapula and shoulder fits acute cholecystitis because the gallbladder is located under the liver in the RUQ, and inflammation irritates the diaphragmatic peritoneum. The phrenic nerve (C3–5) carries that diaphragmatic irritation to the shoulder area, so referred pain is commonly felt at the right shoulder blade/shoulder. This RUQ location with right-sided shoulder radiation is the classic pattern you’d expect with gallbladder inflammation.

As a point of contrast, pain in other areas or radiating to the umbilicus or left side would point toward different abdominal issues (for example, pain primarily in the lower quadrants or umbilical region suggests other organs, and left-sided radiation is less typical for gallbladder problems). Positive Murphy’s sign may also be present, reinforcing RUQ gallbladder pathology.