A 48-year-old woman comes to the physician because of recurrent right upper abdominal pain for 3 weeks. The pain usually occurs after meals and tends to radiate to the right shoulder. She reports that she otherwise feels well. She has more energy since she started an intermittent fasting diet and has rapidly lost 9.0 kg (20 lbs). She is 160 cm (5 ft 3 in) tall and weighs 100 kg (220 lb); BMI is 39 kg/m2. Physical examination shows a nontender abdomen. Abdominal ultrasonography shows several small stones in the gallbladder without calcification. When discussing treatment options, she states that she does not wish to undergo surgery and asks about other possibilities. Which of the following is the most appropriate pharmacotherapy to address the underlying cause of this patient's condition?

Question

Quizplus · Accepted Answer

Eductional Objective: Bile cholesterol oversaturation, bile stasis, and impaired bile acid circulation promote the formation of cholesterol gallstones. Female sex, age > 40 years, obesity, and rapid weight loss, as seen in this patient, are also risk factors for gallstone formation. Cholecystectomy is the first-line therapy for symptomatic cholelithiasis. However, for patients who are unable or unwilling to receive cholecystectomy, ursodeoxycholic acid is the first-line nonsurgical treatment. It dissolves gallstones by solubilizing cholesterol and thus is appropriate for the management of small stones (i.e., < 10 mm) that have minimal calcification. Ursodeoxycholic acid also decreases hepatic secretion of cholesterol, decreases intestinal absorption of cholesterol, and promotes gallbladder emptying.

A 48-Year-Old Woman Comes to the Physician Because of Recurrent