From Bilirubin Blues to Gallstone Bust – How Secretin Saved the Day

January 15, 2024by Dr. S. F. Czar0

Case Study: 

Patient: Sarah M., 42-year-old female

Presenting Complaint: Sarah presented to the emergency department with severe right upper quadrant abdominal pain, nausea, and vomiting. She described the pain as sharp and stabbing, radiating to her back and shoulder blade. She also reported feeling feverish and having dark urine.

Medical History: Sarah had a history of high cholesterol and occasional heartburn, but no previously diagnosed gastrointestinal issues. She was not on any regular medications.

Physical Examination: On examination, Sarah appeared in significant distress due to the pain. Her abdomen was tender to palpation, especially in the right upper quadrant. There was no jaundice, but her sclerae appeared slightly icteric.

Laboratory Tests:

  • Serum bilirubin: elevated (12 mg/dL, normal range: 0.3-1.2 mg/dL)
  • Alkaline phosphatase: elevated (250 IU/mL, normal range: 40-150 IU/mL)
  • Gamma-glutamyl transferase (GGT): elevated (80 IU/mL, normal range: 8-40 IU/mL)
  • Lipase: slightly elevated (60 IU/mL, normal range: 30-160 IU/mL)

Imaging Studies:

  • Abdominal ultrasound: revealed multiple gallstones in the gallbladder, with one stone lodged in the cystic duct.

Diagnosis: Acute calculous cholecystitis (inflammation of the gallbladder due to gallstones) with biliary obstruction.


  • Intravenous fluids and pain management
  • Emergency laparoscopic cholecystectomy (removal of the gallbladder)


Sarah underwent a successful laparoscopic cholecystectomy. Her symptoms resolved quickly after surgery, and her bilirubin levels returned to normal within a few days. She was discharged from the hospital after 3 days and made a full recovery.


This case study illustrates the importance of understanding the role of secretin in preventing gallstones. Sarah’s high cholesterol and potentially decreased bile acid production likely contributed to the formation of gallstones. The presence of a single stone blocking the cystic duct led to bile stasis and inflammation of the gallbladder, causing her severe symptoms.

Early diagnosis and prompt surgical intervention were crucial in preventing further complications, such as cholangitis (inflammation of the bile ducts) and pancreatitis. Additionally, lifestyle modifications like maintaining a healthy weight, eating a balanced diet, and staying hydrated can help prevent gallstone formation in the future.

Key Takeaways:

  • Gallstones are a common digestive disorder, affecting millions of people worldwide.
  • High cholesterol, obesity, rapid weight loss, and certain medications are risk factors for gallstones.
  • Secretin plays a crucial role in bile production and gallbladder emptying, helping to prevent gallstone formation.
  • Acute cholecystitis can be a serious complication of gallstones and requires prompt medical attention.
  • Early diagnosis and treatment can prevent serious complications and improve quality of life.

Sarah and the Hormonal Tug-of-War

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