A 41-year-old woman presents with pain in her abdomen for the last 3 hours. She says pain is intense, dull, constant, and localized to the right upper quadrant. The pain started about 30 minutes after she had a high-fat meal this morning and is accompanied by nausea. She has had similar episodes in the past after a fatty meal, but they were less severe and resolved after an hour. Her past medical history is otherwise noncontributory. Her temperature is 37.6°C (99.6°F), heart rate is 85/min, respiratory rate is 16/min, and blood pressure is 120/80 mm Hg. Physical examination is within normal limits. An abdominal ultrasound is pending. Which of the following hormones is the likeliest cause of the postprandial aggravation of this patient’s symptoms?
Correct answer: Cholecystokinin
General Feedback
This patient most likely has biliary colic. Pain in the right upper quadrant aggravated by fatty meals is typical of cholelithiasis. Although gallstones can be composed of different materials, cholesterol stones are the most common. They form as a result of the supersaturation of bile with cholesterol and a decreased concentration of bile salts and lecithin in the bile.
In the US, about 6% of men and 9% of women have gallstones. Risk factors include female sex, obesity, use of estrogen-containing contraceptive pills, rapid weight loss, and use of certain drugs like fibrates.
Patients are typically asymptomatic unless the stone lodges in the cystic duct. Once this happens, patients may develop right upper quadrant pain following the ingestion of fatty foods. Fatty meals stimulate cholecystokinin (CCK) secretion, which causes the gallbladder to contract, resulting in bile flow from the gallbladder to the duodenum (see image below). If the cystic duct is blocked by a stone, gallbladder contraction will lead to severe pain that is constant and not colicky (despite the term biliary “colic”).
A 41-year-old woman presents with pain in her abdomen for the last 3 hours. She says pain is intense, dull, constant, and localized to the right upper quadrant. The pain started about 30 minutes after she had a high-fat meal this morning and is accompanied by nausea. She has had similar episodes in the past after a fatty meal, but they were less severe and resolved after an hour. Her past medical history is otherwise noncontributory. Her temperature is 37.6°C (99.6°F), heart rate is 85/min, respiratory rate is 16/min, and blood pressure is 120/80 mm Hg. Physical examination is within normal limits. An abdominal ultrasound is pending. Which of the following hormones is the likeliest cause of the postprandial aggravation of this patient’s symptoms?
Correct answer: Cholecystokinin
General Feedback
This patient most likely has biliary colic. Pain in the right upper quadrant aggravated by fatty meals is typical of cholelithiasis. Although gallstones can be composed of different materials, cholesterol stones are the most common. They form as a result of the supersaturation of bile with cholesterol and a decreased concentration of bile salts and lecithin in the bile.
In the US, about 6% of men and 9% of women have gallstones. Risk factors include female sex, obesity, use of estrogen-containing contraceptive pills, rapid weight loss, and use of certain drugs like fibrates.
Patients are typically asymptomatic unless the stone lodges in the cystic duct. Once this happens, patients may develop right upper quadrant pain following the ingestion of fatty foods. Fatty meals stimulate cholecystokinin (CCK) secretion, which causes the gallbladder to contract, resulting in bile flow from the gallbladder to the duodenum (see image below). If the cystic duct is blocked by a stone, gallbladder contraction will lead to severe pain that is constant and not colicky (despite the term biliary “colic”).