A pregnant patient presents with right upper quadrant pain after fatty meals and is found to have gallstones. What is the most likely diagnosis?

Correct answer: B. Cholecystitis

• A. APPENDICITIS causes RIGHT LOWER quadrant pain at McBurney point, though the appendix is displaced upward in later pregnancy — but it is not associated with gallstones or fatty-food intolerance.
• B. CORRECT. Gallstones plus right upper quadrant pain provoked by fatty food is CHOLECYSTITIS (inflammation of the gallbladder secondary to cystic duct obstruction by a stone). Pregnancy markedly increases risk: oestrogen raises biliary cholesterol saturation while progesterone reduces gallbladder motility, so bile stasis and stone formation are both promoted. Look for Murphy sign, fever and leucocytosis.
• C. PEPTIC ULCER DISEASE gives epigastric pain related to meals and is linked to H. pylori and NSAIDs, not to gallstones.
• D. PANCREATITIS can certainly be caused by gallstones and is an important complication, but it produces severe EPIGASTRIC pain radiating to the BACK with raised lipase — not the described right upper quadrant fatty-food pattern.

Note: Dental relevance: defer elective care during an acute episode, and be aware that severe vomiting from biliary colic or hyperemesis causes PERIMYLOLYSIS — erosion of the palatal surfaces of the upper anterior teeth. Advise rinsing with water or sodium bicarbonate rather than brushing immediately after vomiting.