<prompt> Untrue about acute cholecystitisJaundice is the earliest symptomMild raise in serum bilirubin levelRight upper quadrant painVomiting is relatively common  <response>: 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 