CHOLELITHIASIS

Cholesterol Gallstones Black Pigmented Gallstones Brown Pigmented Gallstones

Non-modifiable Factors: Modifiable Factors: Non-modifiable Factors: Modifiable Factors: Non-modifiable Factors:
volume of unconjugated Lifestyle E. Coli Age: >40 years old
Age: >40 years old Lifestyle Age: >40 years old
bilirubin in bile Systemic Disorders that Ascaris Lumbrcoides Gender: Female
Gender: Female Systemic Diseases Gender: Female
result in excessive (roundworm) Genetic
Genetic Obesity & Insulin Resistance Genetic
bilirubin production Clonorchis sinesis (liver fluke) Predisposition
Predisposition DM Predisposition
Geography/Ethnicity: Diseases of the Ileum Geography/Ethnicity: Bilirubin precipitates Hemolytic anemia Geography/Ethnicity:
Western countries Spinal cord injuries Western countries Cirrhosis Asian Countries
Biliary tract E. Coli invasion in the
Drugs
infections gallbladder
Estrogen, Clofibrate, Ca2+ readily binds with bilirubin
Ostreotide, Ceftriaxone
Total Parenteral Nutrition
Brings about hydrolytic enzymes
Gallbladder hypersecretes Diet
Formation of solid Ca2+ that hydrolyzes both conjugated
mucins, as a result of Rapid weight loss
Supersaturated bile formation bilirubinate bilirubin and phospholipids
stimulation by some Pregnancy and Parity
components of saturated bile
Cholesterol content can't be Agglomeration Hydrolyzed components
solubilized at equilibrium by bile precipitate along with Ca2+
Carbohydrate groups of the
salts and phospholipids
polymers of mucins avidly bind
Growth of the crystals into
to H2O to form gels
mature and macroscopic stones Agglomeration
With the presence of
heterogeneous pronucleating
The hydrophobic polypeptides in Black-pigmented Ca2+
agents, cholesterol precipitates Growth of the crystals into
the core of mucin glycoproteins bilirubinate gallstones mature and macroscopic stones
bind with bilirubin and Ca in bile
Cholesterol nucleation and
crystallization Brown-pigmented stones
Results to H2O-insoluble
complex of mucin glycoproteins = UCB + hydrolyzed phospholipids
and Ca Bilirubinate + Ca2+
Formation of solid plate-like
cholesterol monohydrate
crystals in bile
Provides a surface for nucleation
of cholesterol monohydrate
crystals and a matrix for growth Gallbladder stasis facilitates
of stones Agglomeration retention

Growth of the crystals into

mature and macroscopic stones

Cholesterol gallstones