A 39-year-old lady arrives at the emergency room after experiencing multiple episodes of acute upper abdominal discomfort. Her discomfort is caused by fatty meals and disappears on its own. The symptoms began a few months earlier, following an uneventful pregnancy. The patient's previous medical history is remarkable for hypertension, which is treated with a calcium channel blocker, and hypertriglyceridemia, which is managed with a fibrate. The temperature is 37.2 degrees Celsius (98.9 degrees Fahrenheit), and the blood pressure is 143/76 mm Hg. The patient is 173 cm (5 ft 8 in) tall and weighs 95 kg (210 lb). Ultrasound demonstrates gallbladder wall thickening, with discomfort provoked by placing the ultrasound probe directly over the gallbladder. She has a laparoscopic cholecystectomy, and numerous stones are found in the gallbladder contents. Decreased activity of which of the following enzymes would most likely have contributed to this patient's condition?

Question

Quizplus · Accepted Answer

Eductional Objective: Fibrate drugs (for example, fenofibrate and gemfibrozil) block cholesterol 7-hydroxylase, which catalyzes the rate-limiting step in bile acid production. Reduced bile acid synthesis reduces cholesterol solubility in bile, which promotes the development of cholesterol gallstones.

A 39-Year-Old Lady Arrives at the Emergency Room After Experiencing