Gallstones Quiz: Ace Your Exams

A 37-year-old woman, gravida 5 para 5, is brought to the emergency department due to sudden-onset colicky abdominal pain in the right upper quadrant that started 1 hour ago. She states she has been feeling nauseous for several hours since the pain started and has vomited twice. She has had several episodes of abdominal discomfort in the past, especially after consuming food. Medical history is significant for hypertriglyceridemia and obesity. Medications include fenofibrate. Temperature is 38.0°C (100.4°F), pulse is 75/min, and blood pressure is 135/85 mmHg. BMI is 36 kg/m². Abdominal examination reveals inspiratory arrest during palpation of the right upper quadrant. An abdominal ultrasound shows a thickened gallbladder wall and exquisite tenderness when the probe is applied on the right upper quadrant. A diagnosis is made, and the patient receives pain medication and IV hydration. Two weeks later, the patient undergoes elective laparoscopic cholecystectomy which reveals multiple stones within the gallbladder. Which of the following is the most likely cause of this patient’s condition?