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| Cholelithiasis |
| Etiology •Unknown |
| Pathogenesis •The pathogenesis of cholesterol stones is different from that of pigmented stones. •Cholesterol is essentially insoluble in water, but is kept in solution in bile by the presence of bile soluble salts and lecithins. •Conditions that favor increase in biliary cholesterol promote stone formation and include obesity, high calorie diets, rapid weight loss and pregnancy. •Abnormal gallbladder motor function, with delayed emptying and stasis apparently promote the formation of gallstones as well. •Biliary sludge, a thick mucous material that forms in the most dependent portion of the gallbladder also promotes nucleation with the formation of stones. •Pigmented stones, on the other hand, appear to form predominantly as a result of infection of the biliary tract with bacterial or parasitic agents. •Increase in hemolysis resulting in increased production of bile pigment in the gallbladder may also promote the formation of gallstones., |
| Epidemiology •Gallstones afflict 10-20% of adult population. •Far more common in women, with a female ratio of approximately 2:1. •European people, of advancing age, female sex with a tendency to obesity, and a history of rapid weight loss are particularly prone to develop cholesterol stones. •Pigmented stones, on the other hand, are far more often seen in Asian people, particularly with disorders of hemoglobin, resulting in an increase in hemolysis. |
| General Gross Description •Gallstones are crystalline structures, formed by gradual accretion of components of bile. •Grossly, pure cholesterol stones are yellow, and on section, reveal a classic radiating pattern. •Pigmented gallstones can be jet black. •These are usually associated with a sterile gallbladder and are due to increased hemolysis. •Brown pigmented stones are often associated with a repeated history infection. |
| General Microscopic Description •Stones are too hard to be subjected to routine histology and sections are not obtained. |
| Clinical Correlation •Seventy to eighty percent of patients with gallstones remain asymptomatic throughout their lives. •About 1-3% of these patients exhibit symptoms in any given year. •The risk decreases with age. |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 889 • Harrison's Principles of Internal Medicine, 13th Ed: Isselbach et. al. (eds). New York, McGraw-Hill, 1994, pp. 1505 |
| Cholelithiasis |
| Synopsis by: T.V.Rajan, M.D., Ph.D. (T57000M30010)[584] |
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