Chapter 23, Problem 2CCS

48-Year-Old Female with Gallstones

Ms. Burton, 48, presents at the clinic complaining of abdominal pain. She is a middle-aged woman, overweight, pale and sweating, with jaundice (yellowish skin and sclerae). Her heart rate is 102 beats/min and BP is 145/98 mm Hg. She describes the pain as “severe” and “steady” over the past night, accompanied by nausea and vomiting. She sits leaning forward and indicates that the pain is in the epigastric region radiating up to the tip of the right shoulder.

Ms. Burton’s medical history shows that she has had several episodes of biliary colic (pain caused by gallstones going through the bile duct). She says her current pain is "sort of like that, but it’s lasted longer." She says her last meal was a seven-cheese pizza the previous night, and that the pain began 3–4 hours after eating. She denies drinking or smoking.

2. Why would pain related to gallstones begin after a high-fat meal?