A 58-yo old male was involved in a serious MVA. Besides a femur fracture, the CT scan revealed a splenic laceration. Because of his hemodynamic instability he was quickly resuscitated and taken to the operating room for exploration. The splenic laceration was fixed with surgical glue and hemostatic sutures. During the abdominal exploration, a specimen was removed with the following contents (See image). His postoperative recovery was uneventful. Later it was revealed that he was on a medication to lower his lipids. The mechanism of action of the medication most likely responsible for the contents shown in the image involves:
A. Inhibition of HMG CoA reductase
B. Stimulating activity of lipoprotein lipase
C. Inhibition of alpha-glucosidase
D. Increased biliary cholesterol secretion
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The image shows presence of gallstones. One medication associated with de-novo formation of gallstones is gemfibrozil.
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Fibrates are widely used to lower serum triglyceride levels and increase high-density lipoprotein (HDL) in patients with hypertriglyceridemia.
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The drug acts on the liver by increasing lipoprotein lipolysis and fatty acid uptake, decreased triglyceride production, and increased low-density lipoprotein (LDL) removal and reverse cholesterol transport.
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Fibrates do cause mild stomach upset and myopathy. Fibrates also lower the synthesis of bile acid by down-regulation of cholesterol 7alpha-hydroxylase and sterol 27-hydroxylase expression; this action makes it easier for cholesterol to precipitate and increasing the risk for gallstones.
