Gallstone

Pathophysiology

Lithogenic Bile

• Supersaturation of bile with substances like cholesterol or calcium bilirubinate forming monohydrate crystals.
• The crystals are trapped in gallbladder mucus, producing gallbladder sludge.
• Over time, the crystals grow, aggregate, and fuse to form macroscopic stones.

Stasis

• Supersaturation of bile with substances like cholesterol or calcium bilirubinate forming mo

Type

1. Cholesterol (80%)

• contain >70% cholesterol, large, usually green, radiolucent
• Risk : female, fat, fertile, forties, fair (caucassian), DM, pancreatitis, malabsoption, terminal ileal resection, IBD, smoking, Native American (Pima tribe)

2.  Pigment stones (20%) 

• < 20% cholesterol, small, dark, friable, irregular, may be radio opaque
• due to infection with B-glucuronidase bacteria
• Risk : haemolytic anemia, biliary tract infection, cirrhosis

3.  Mixed

• 30-70% cholesterol, faceted (calcium salts, pigment, cholesterol)

Prevalence

• 8% of those aged over 40
• 90% asymptomatic
• May present as biliary colic, acute cholecystitis, cholangitis, pancreatitis, GS ileus.