Question

A 44-year-old obese woman presents with abdominal pain. She says the pain started while she was having lunch at a fast-food restaurant with her children. The pain began shortly after eating and has persisted for 6 hours. She has vomited once. Her vital signs are as follows: HR 88, BP 110/70 mmHg, T 38.5°C (101.3°F). On physical exam, she is tender to palpation in the right upper quadrant of her abdomen. Her skin appears normal. Her liver function tests, amylase, and lipase levels are normal. A right upper quadrant abdominal ultrasound is challenged by her body habitus and is not able to visualize any gallstones. Which of the following is the most likely cause of her presentation?

a. Acalculous cholecystitis
b. Cancer of the biliary tree
c. Gallstone disease
d. Pancreatic inflammation
e. Cholangitis

Answer 1

The most likely cause of the obese woman's presentation with abdominal pain after eating, vomiting, and right upper quadrant tenderness is gallstone disease.

Step-by-step explanation:

The 44-year-old obese woman with abdominal pain, which started after eating and includes vomiting and tenderness in the right upper quadrant, is most likely experiencing gallstone disease. The presence of abdominal pain, particularly postprandial pain in the right upper quadrant, along with nausea and vomiting, is indicative of gallstones. While the ultrasound was inconclusive likely due to her body habitus, the symptoms align with gallstone disease more than the other options listed. Acalculous cholecystitis is less likely without a history of critical illness or immobility, cancer of the biliary tree typically presents with painless jaundice, pancreatic inflammation would likely cause abnormal amylase or lipase levels, and cholangitis generally presents with Charcot's triad (fever, jaundice, and right upper quadrant pain).