Chronic haemolysis in sickle cell (HbSS) disease raises unconjugated bilirubin in bile and causes black pigment gallstones. Recurrent episodes of RUQ pain radiating to the right shoulder with nausea, no fever and normal vitals is biliary colic from gallstones; the scleral icterus reflects haemolysis (or a passing stone). Acute hepatitis would not give repeated self-limiting colicky episodes, pneumonia would cause fever/respiratory signs, and appendicitis is a single RLQ illness.