20th July 2023

A 55-year-old woman presents to the emergency department with intermittent right upper quadrant pain

A 55-year-old woman presents to the emergency department with intermittent right upper quadrant pain that is associated with nausea and occasional episodes of vomiting. She is afebrile and denies jaundice. On systems review, she reports a 9-month history of continuous loose bowel motions that are “smelly and greasy-looking.” There is associated intermittent cramping abdominal pain. These symptoms have persisted despite cutting both gluten and lactose from her diet. Previously her GP had diagnosed irritable bowel syndrome. She has no other past medical history and takes no regular medications. Her observations are within normal range. Her blood tests, including full blood count, liver function, renal profile, CRP and ESR, are unremarkable. An abdominal ultrasound reveals the presence of gallstones.

Based on the clinical presentation, what is the most likely cause of this woman’s diarrhoea?

Select the SINGLE most appropriate option from the list below. Select ONE option only.