Cholecystolithiasis
Definition
- The presence of gallstones in the gallbladder
- If the gallstones are in the common bile duct, it’s called choledocholithiasis
- Gallstones are hardened deposits of digestive fluid (e.g. bile)
- Bile consists of 70% bile salts and acids, 10% cholesterol, 5% phospholipids (e.g.
lecithin), 5% proteins, 1% bilirubin, and the rest are small amounts of water,
electrolytes (such as Ca2+) and bicarbonate
Epidemiology
- Prevalence: 10-15% of the adult population
- Mainly Native American and North America Indians
- Prevalence is higher in women than men
- The older, the higher the risk for gallstones
Morphology
- Gallstones range in size from as small as a grain of sand to as large as a golf ball
- Some people develop just one gallstone while others develop many at the same time
- There are 2 types of gallstones
o Cholesterol gallstones
This is the most common one (75-90% of cases) and often appears
yellow in color
They are mainly composed of undissolved cholesterol
When Ca2+ and bicarbonate combine, they form CaCO3 (calcium
carbonate) —> if this happens, the stones can be visible on an X-ray,
otherwise they cannot be seen
o Pigment/bilirubin gallstones
These appear dark brown or black in color
These mainly form when the bile contains too much bilirubin
Ca2+ and bilirubin combine, they form calciumbilirubinate —> since
they mainly consist of calcium, these are visible on an X-ray
98-99% of bilirubin in bile is conjugated, but 1-2% is unconjugated, BUT
bilirubin in pigment stones is unconjugated! (mechanism still unclear
why and how this happens)
Figure 1: Differences between the typs of gall stones. Source: Stinton, L. M., & Shaffer, E. A. (2012). Epidemiology of
gallbladder disease: cholelithiasis and cancer. Gut and liver, 6(2), 172–187. https://doi.org/10.5009/gnl.2012.6.2.172
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Definition
- The presence of gallstones in the gallbladder
- If the gallstones are in the common bile duct, it’s called choledocholithiasis
- Gallstones are hardened deposits of digestive fluid (e.g. bile)
- Bile consists of 70% bile salts and acids, 10% cholesterol, 5% phospholipids (e.g.
lecithin), 5% proteins, 1% bilirubin, and the rest are small amounts of water,
electrolytes (such as Ca2+) and bicarbonate
Epidemiology
- Prevalence: 10-15% of the adult population
- Mainly Native American and North America Indians
- Prevalence is higher in women than men
- The older, the higher the risk for gallstones
Morphology
- Gallstones range in size from as small as a grain of sand to as large as a golf ball
- Some people develop just one gallstone while others develop many at the same time
- There are 2 types of gallstones
o Cholesterol gallstones
This is the most common one (75-90% of cases) and often appears
yellow in color
They are mainly composed of undissolved cholesterol
When Ca2+ and bicarbonate combine, they form CaCO3 (calcium
carbonate) —> if this happens, the stones can be visible on an X-ray,
otherwise they cannot be seen
o Pigment/bilirubin gallstones
These appear dark brown or black in color
These mainly form when the bile contains too much bilirubin
Ca2+ and bilirubin combine, they form calciumbilirubinate —> since
they mainly consist of calcium, these are visible on an X-ray
98-99% of bilirubin in bile is conjugated, but 1-2% is unconjugated, BUT
bilirubin in pigment stones is unconjugated! (mechanism still unclear
why and how this happens)
Figure 1: Differences between the typs of gall stones. Source: Stinton, L. M., & Shaffer, E. A. (2012). Epidemiology of
gallbladder disease: cholelithiasis and cancer. Gut and liver, 6(2), 172–187. https://doi.org/10.5009/gnl.2012.6.2.172
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