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Gallstone Obstruction and Associated Gallbladder Inflammation (Cholecystitis) Pathophysiology 1

Gallstone obstruction and associated gallbladder inflammation (cholecystitis) pathophysiology


Vignette: A 45-year-old man presents to the emergency department with severe abdominal pain. He reports that his pain started suddenly this morning and has been constant ever since. He also mentions that he has been feeling nauseous and vomited twice before coming to the hospital. He has a past medical history of gallstones. On physical examination, the abdomen is tender to palpation, especially in the right upper quadrant. An ultrasound of the abdomen shows an enlarged gallbladder with a single stone lodged in the cystic duct.

Question: What is the pathophysiological mechanism underlying the patient's symptoms?


A) Impaired fatty acid absorption

B) Obstruction of the common bile duct

C) Inflammatory response to gallstone impaction

D) Biliary colic due to gallbladder contraction

E) Pancreatitis due to backflow of bile into the pancreatic duct


C) Inflammatory response to gallstone impaction


This patient's symptoms and ultrasound findings are indicative of acute cholecystitis, which typically occurs due to a gallstone obstructing the cystic duct. This obstruction leads to distention and inflammation of the gallbladder. The pain is caused by the distention and the inflammation of the gallbladder wall, which is due to an inflammatory response to the gallstone impaction. Therefore, the correct answer is C) Inflammatory response to gallstone impaction.

Option A) is incorrect because impaired fatty acid absorption occurs in diseases where bile release into the small intestine is compromised, such as in obstruction of the common bile duct (Option B). However, this patient's ultrasound showed a stone in the cystic duct, not the common bile duct.

Option D) biliary colic due to gallbladder contraction, is a less likely option as biliary colic is characterized by episodic right upper quadrant pain, not constant pain as seen in this patient.

Option E) is incorrect because pancreatitis due to backflow of bile into the pancreatic duct would likely present with more diffuse abdominal pain, elevated amylase and lipase levels, and would not necessarily be associated with an enlarged gallbladder on ultrasound.


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