A 63-year-old woman with known cholelithiasis presents with fever, jaundice, and right upper quadrant pain. Vital signs show BP 88/54, HR 118, RR 22, temperature 39.2°C, and SpO2 98% on room air. She is increasingly confused. Laboratory studies reveal elevated transaminases and direct hyperbilirubinemia; abdominal ultrasound shows dilated intrahepatic bile ducts. She denies recent antibiotic use. Which of the following is the most likely diagnosis?

1. A)Acute cholecystitis
2. B)Acute cholangitisGABARITO
3. C)Primary biliary cholangitis
4. D)Biliary colic
5. E)Pancreatic adenocarcinoma