Step 1

Gastrointestinal 3

A 57-year-old woman presents to the emergency department for severe, constant, right upper quadrant abdominal pain for the past week. Over this time period, she reports inability to pass bowel movements or flatus, and she endorses nausea with a few episodes of non-bloody, non-bilious vomiting. She has a history of recurrent cholelithiasis but has declined surgery in the past. Vital signs are within normal limits except for a heart rate of 110 beats/min. Physical examination reveals that her abdomen is diffusely tender and distended with hypoactive bowel sounds. Abdominal X-ray shows free air in the biliary tree.

Which of the following describes the pathophysiology of the most likely complication of the patient's gallstone condition?

  • A) Acute inflammation of the gallbladder due to calculous deposits at the cystic duct
  • B) Common hepatic duct obstruction due to extrinsic compression from an impacted gallstone in the cystic duct
  • C) Gallstone passage through a fistula between the gallbladder and small bowel causing impaction at the ileocecal valve
  • D) Obstruction of the common bile duct due to dislodged gallstone
  • E) Obstruction of the pancreatic duct due to dislodged gallstone


Rishab Chawla


Dr. Ted O'Connell