Gallbladder disorders Quiz: Ace Your Exams

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A 40-year-old woman is brought to the emergency department due to acute onset of abdominal pain, intense sweating, and vomiting. The pain is sharp, constant, 8/10 in intensity and radiates to the right shoulder blade. The patient has 2 children who were both delivered by cesarean section. Medical history is significant for diabetes mellitus type 2 and obesity. Temperature is 37.0°C (98.6°F), pulse is 70/min, and blood pressure is 135/85 mmHg. BMI is 37 kg/m2. ECG shows no abnormalities. An abdominal ultrasound is inconclusive due to body habitus. Further testing is performed, and the laboratory results are shown below:  
 
 Laboratory value  Result 
 Hemoglobin  14.5 g/dL 
 Leukocyte count  8000 mm3 
 Platelet count    230,000 mm3 
 Mean corpuscular volume  85 μm3 
 Serum  
 Creatinine   0.6 g/dL 
 BUN  10 mg/dL 
 Bilirubin   
 Total   0.8 mg/dL 
 Direct  0.2 mg/dL 
 Alanine aminotransferase (ALT, GPT  15 U/L 
 Aspartate aminotransferase (AST, GOT  17 U/L 
 Amylase  50 U/L 
 Lipase  65 U/L 
 Alkaline phosphatase   60 U/L 
Which of the following is the most likely diagnosis?

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