Describe the formation of gallstones and explain how choledocholithiasis and cholangitis could interfere with bile flow.

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Overview
A 40-year-old woman presents in the emergency department with a sudden episode of vomiting and severe right epigastric pain that developed after eating a fatty evening meal. Although there is no evidence of jaundice in her skin, the sclera of her eyes is noted to have a yellowish discoloration. Palpation reveals tenderness of the upper right quadrant with muscle splinting and rebound pain. Right upper quadrant abdominal ultrasonography confirms the presence of gallstones. The woman is treated conservatively with pain and antiemetic medications. She is subsequently scheduled for a laparoscopic cholecystectomy.
Tasks
Please address the following:
Describe the formation of gallstones and explain how choledocholithiasis and cholangitis could interfere with bile flow.
How would this increase the potential for hepatic and pancreatic complications?
Relate this woman’s signs and symptoms to gallstones and their effect on gallbladder function.
Explain the initial appearance of jaundice in the eyes as opposed to the skin. Which of the two laboratory tests for bilirubin would you expect to be elevated—direct (conjugated) or indirect (unconjugated or free)?
What effect will removal of the gallbladder have on the storage and release of bile into the intestine, particularly as it relates to meals?
Please cite your sources using APA Style 7th edition.

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