Untrue about acute cholecystitis

(A) Jaundice is the earliest symptom # ACUTE CHOLECYSTITIS often begins as an attack of biliary pain that progressively worsens.> Approximately 60 to 70% of patients report having experienced prior attacks that resolved spontaneously.> As the episode progresses, however, the pain of acute cholecystitis becomes more generalized in the right upper abdomen.> As with biliary colic, the pain of cholecystitis may radiate to the interscapular area, right scapula, or shoulder.> Peritoneal signs of inflammation such as increased pain with jarring or on deep respiration may be apparent.> The patient is anorectic and often nauseated.> Vomiting is relatively common and may produce symptoms and signs of vascular and extracellular volume depletion.> Jaundice is unusual early in the course of acute cholecystitis but may occur when edematous inflammatory changes involve the bile ducts and surrounding lymph nodes.> The serum bilirubin is mildly elevated in fewer than half of patients, while about one-fourth have modest elevations in serum aminotransferases (usually less than a fivefold elevation)> The radionuclide (e.g., HIDA) biliary scan may be confirmatory if bile duct imaging is seen without visualization of the gallbladder.> Ultrasound will demonstrate calculi in 90 to 95% of cases