WBR0657
| Author | [[PageAuthor::Gerald (Reviewed by Alison Leibowitz)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathophysiology |
| Sub Category | SubCategory::Gastrointestinal |
| Prompt | [[Prompt::An obese 48-year-old, multiparous female, presents to the physician's office with nonradiating right upper quadrant pain, nausea, bloating, and vomiting that becomes worse after the consumption of fries and a hamburger. Ultrasonography displays hyperechogenic foci within the right upper quadrant. Laboratory testing reveals a WBC count of 16,000/mm3 and a serum amylase level of 70 U/L. Which of the following substances results in her right upper quadrant pain?]] |
| Answer A | AnswerA::Cholecystokinin |
| Answer A Explanation | AnswerAExp::See overall explanation |
| Answer B | AnswerB::Gastrin |
| Answer B Explanation | AnswerBExp:: |
| Answer C | AnswerC::Pepsin |
| Answer C Explanation | AnswerCExp:: |
| Answer D | AnswerD::Secretin |
| Answer D Explanation | AnswerDExp:: |
| Answer E | AnswerE::Gastric inhibitory peptide |
| Answer E Explanation | AnswerEExp:: |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::The patient in this scenario demonstrates symptoms, as well as laboratory and imaging results, which are suggestive of gallstone cholecystitis. Gallstone cholecystitis is typically presented in patients who fit the profile of the “4F’s”: Female, Fat, Fertile, and Forty. The right upper-quadrant pain that results from gallbladder contraction, is induced by cholecystokinin (CCK), which secretes in response to the presence of peptides, amino acids, and fatty acids in the duodenum.
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gallbladder contraction, which produces right upper quadrant pain in an obese, middle-aged, multiparous women with ultrasonographic findings consistent with gallstones is a classic presentation of acute calculous cholecystitis. Acute calculous cholecystitis is an acute mechanical inflammation of the gallbladder commonly resulting from a gallbladder stone obstructing the gallbladder neck or cystic duct, chemical inflammation, and/or bacterial inflammation. Educational Objective: Gallstone cholecystitis, induced by cholecystokinin, is typically presented in patients who fit the profile of the “4F’s”: Female, Fat, Fertile, and Forty. |
| Approved | Approved::No |
| Keyword | WBRKeyword::Gallstone ileus, WBRKeyword::Cholelithiasis, WBRKeyword::Cholecystitis |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |