hi this is dr.subhadeep.thanks for the opportunity to help you. as per your description it looks like acute cholecystitis or acute on chronic cholecystitis.if it is acute on chronic cholecystitis symptoms won t be so severe and so Murphy s sign may be negative. pain can also be due to hepatomegaly as a result of hepatitis or there can also be some distal CBD stone.kindly tell me if you have observed or people told you that your eyes have turned yellow or you have itching sensation over your body or yellow urine or muddy clay coloured stools.these r all signs of obstructive jaundice due to distal BCD stones.to rule out GB or CBD stone following approach should be implemented:- 1)complete haemogram and WBC count.if counts are high it shows acute infection with test for HAV,HBsAg etc. 2) LFT 3)USG 4)CECT abdomen will be far superior to diagnose GB or CBD stone if renal parameters r normal. 5)MRI scan if altered renal parameters. if you have GB stones with DM then you should undergo elective lap cholecystectomy at the earliest as diabetes can lead to emphysema or perforation of the gall bladder.if u have CBD stones or both GB and CBD stones then ERCP followed by sphincterotomy and then elective lap cholecystectomy after 7-10 days should be done. if ERCP followed by sphincterotomy fails then open CBD exploration or lap CBD exploration with cholecystectomy depending on the diameter of CBD , size of stone and expertise of surgeon.a surgical gastroenterologist handling this case will be a better choice. If it turns out to be hepatitis or fatty liver then patient has to take bland and carbohydrate rich , fat and protein free diet with tab liv-52 ds tablets tab udiliv and tab sylibion as directed by your treating doctor. very rarely right sided renal stones can give pain in rt.hypochondrium a CECT whole abdomen will be ideal if renal parameters r okay.if not USG or even X-Ray KUB after proper bowel preparation can be done. if the size of the stone is less than 5mm without hydronephrosis then he should be advised to take 4-5 litres of water daily,avoid high protein,tomatoes,spinach.should be put on t. Norfolk and syrup. citralka.if pain subsides patient is advised to review after 3 months for follow up with repeat USG if size of the stone is more than 5 mm with hydronephrosis then patient should be referred to urologist for further management extreme rare case of sub hepatic appendix may also be there as RIF is free.in these case open or laparoscopic appendicectomy as per expertise of surgeon as duration is not mentioned in rarest condition it can be a carcinoma of HEPATOBILIARY tract . in that case refer the patient to surgical gastro for further management. hope this consultation was beneficial regards