A 43-year-old obese woman presents to the emergency room with severe epigastric pain that started after a heavy meal. She has had several milder episodes before related to fatty food consumption. Physical examination reveals marked tenderness in the right subcostal area. Which of the following hormones most likely provoked the current attack in this patient?

Question

A 43-year-old obese woman presents to the emergency room with severe epigastric pain that started after a heavy meal.  She has had several milder episodes before related to fatty food consumption.  Physical examination reveals marked tenderness in the right subcostal area.  Which of the following hormones most likely provoked the current attack in this patient?

Quizplus · Accepted Answer

11ec160b_3cc1_87b3_9249_f578ccba09f2_MD0001_00 This patient presents with classic signs and symptoms of biliary colic. Moreover, she has three well-known risk factors for gallbladder disease ("forty," "fat," and "female"). Cholecystokinin (CCK) is the hormone responsible for gallbladder contraction. It is produced by I cells of the duodenum and jejunum when fat-protein-rich chyme enters the duodenum. It functions to increase pancreatic enzyme secretion (by acinar cells) and gallbladder contraction, and to decrease gastric emptying. In cholecystitis, fatty foods increase CCK production and pain occurs when an inflamed and/or obstructed gallbladder contracts. (Choice A) Secretin promotes bicarbonate secretion from pancreatic ductal epithelium. It has no effect on pancreatic enzyme secretion. (Choice C) Gastrin is a hormone made in the stomach in response to stomach distention, peptides, and vagal stimulation. It stimulates gastric acid secretion and motility. (Choice D) Vasoactive intestinal peptide (VIP) is produced in the pancreas and stimulates intestinal water secretion, counteracts gastrin in the stomach, and promotes bicarbonate secretion for the pancreas. (Choice E) Motilin is a hormone made in the small intestine that promotes intestinal motility. (Choice F) Somatostatin is a hormone made in numerous tissues (hypothalamus, stomach, intestine, pancreas) in response to low pH. Its production is inhibited by vagal stimulation. Somatostatin inhibits the release of growth hormone (GH) and thyroid stimulating hormone (TSH), and suppresses the release of myriad other molecules (e.g. gastrin, CCK, VIP, secretin, insulin, glucagon). Educational objective: Cholecystokinin (CCK) is the hormone responsible for gallbladder contraction. It is made in the duodenum and jejunum in response to fatty acids and amino acids.

A 43-Year-Old Obese Woman Presents to the Emergency Room with Severe