Question

A 42-year-old morbidly obese woman is referred back to her primary care provider to supervise her weight loss program. A surgeon evaluated her for a 'gallbladder attack' 1 month ago, which then resolved; she currently denies abdominal pain. When examined via ultrasound, she still has visible stones in the gallbladder. She declined to have surgery until she achieves her initial weight loss goal of 50 pounds. She is on a supervised healthy diet of about 1200 kilocalories daily; she exercises 1 hour a day 6 days per week. She is losing about 15 - 16 pounds a month.

What intervention would be most effective at preventing the recurrence of her gallbladder "attack" until she achieves her weight loss goal?

1. Prescribe orlistat
2. Prescribe ursodiol
3. Recommend over-the-counter omeprazole
4. Reduce patient's exercise
5. Restrict caloric consumption further

Answer 1

The most effective option for preventing the recurrence of gallbladder attacks while the patient pursues weight loss is to prescribe ursodiol, which helps dissolve cholesterol gallstones.

Step-by-step explanation:

The most effective intervention for preventing the recurrence of a gallbladder attack in the patient described would be to prescribe ursodiol. Ursodiol is a medication that helps dissolve cholesterol gallstones, which are likely causing the attacks, by reducing the amount of cholesterol secreted into bile. It can be a viable nonsurgical option for patients with symptomatic gallstones who are not candidates for surgery or choose to avoid it.

Option one, prescribing orlistat, is not the best choice since it is designed to reduce fat absorption and could potentially increase the risk of gallstone formation due to rapid weight loss. Options three, four, and five are not directly related to gallstone management and may not prevent the occurrence of gallbladder attacks. Moreover, excessive reduction of caloric intake or exercise may have negative health consequences.