43-year-old woman presents to the emergency department with the acute
onset of abdominal pain. Her pain is located to the right upper quadrant (RUQ)
and radiates to the right shoulder. She reports nausea and vomiting but no fever
or chills. The RUQ pain is worse after she eats fatty meals. On examination,
the patient has severe RUQ tenderness. Her white blood cell count is elevated,
as are her liver function tests and alkaline phosphatase level. The amylase and
lipase levels are normal. An abdominal ultrasound reveals an enlarged gallbladder
with multiple stones and gallbladder wall thickening. She subsequently
is admitted to the hospital and undergoes a cholecystectomy.
◆ Why