Which of the following are risk factors for acute cholecystitis in a female patient presenting to the ER?

• A. Both A & C
• B. OCP use
• C. Fenofibrate use
• D. Family history of gallstones

Answer: (A)

Acute cholecystitis most often comes from obstruction of the cystic duct by a gallstone, and a key driver of cholesterol gallstones is changes in bile composition or biliary stasis that promote stone formation in reproductive-age women.

Estrogen-containing oral contraceptives increase hepatic cholesterol secretion into bile and can slow gallbladder emptying, leading to cholesterol stone formation. Fenofibrate, a fibrate, also tends to increase cholesterol saturation of bile, promoting cholesterol gallstones. When stones form and obstruct the cystic duct, the gallbladder becomes inflamed, causing acute cholecystitis.

Family history of gallstones indicates genetic susceptibility to stones in general, but the question highlights direct medication-related risk factors that actively promote stone formation; that’s why the combination involving OCP use and fenofibrate use best fits the scenario.