CASE 19
A 40-year-old obese female presents to the emergency center with complaints
of worsening nausea, vomiting, and abdominal pain. Her pain is located in the
midepigastric area and right upper quadrant. She reports a subjective fever and
denies diarrhea. Her pain is presently constant and sharp in nature but previ-
ously was intermittent and cramping only after eating “greasy” foods. On
examination she has a temperature of 37.8°C (100°F) with otherwise normal
vital signs. She appears ill and in moderate distress. She has significant mide-
pigastric and right upper-quadrant tenderness. Some guarding is present but no
rebound. Her abdomen is otherwise soft with no distention and active bowel
sounds. Laboratory values were normal except for increased liver function
tests, white blood cell count, and serum amylase. Ultrasound of the gallblad-
der revealed numerous gallstones and a thickening of the gallbladder wall.
A surgery consult was immediately sought.
What is the most likely diagnosis?
What is the role of amylase in digestion?
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