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Gallbladder Pathology Online

Pathology of Cholelithiasis (gallstones)

Dr Sampurna Roy MD 

 

Cholelithiasis is defined as the presence of stones within the lumen of the gall bladder or in the extrahepatic biliary tree.

  

Gallstones vary in composition. Sometimes they consist entirely of cholesterol, or of calcium bilirubinate.

More often they are composed of alternating layers of cholesterol, calcium bilirubinate, or cholesterol and calcium carbonate and phosphate.

Protein is another constituent.

Mixed cholesterol stones are the commonest.

Pure cholesterol stones are unusual and pigment stones account for approximately 20% but are much more common in Asian countries.

Black and brown pigment stones exist.

Black pigment stones are more usually associated with hematological disorders and brown ones are formed in association with infection.

Pigment stones are always associated with crumbly stone debris.

In cholelithiasis the gall bladder may show any number of changes, it may be normal or have mild hypertrophy of the muscle coat with some loss of mucosa and variable chronic inflammation is seen.

Biliary fistulas may lead to gall stone ileus if the fistula is duodenal.

Clinical course of gallstones:

Gallstones may remain "silent" in the gallbladder for many years, and few patients ever die of cholelithiasis itself.

One study that followed patients with initially asymptomatic gallstones for upto 11 years found that half remained asymptomatic, one-third developed significant symptomatology, and fewer than 20% developed serious complications.

The incidence of severe complications rose with increasing age. 

Some studies indicate that the 15-year cumulative probability that asymptomatic stones will lead to biliary pain or other complications is less than 20%.

These statistics bear upon the question of whether to perform cholecystectomy for asymptomatic gallstones.

In some otherwise healthy individuals, the small risk associated with cholecystectomy may justify elective surgery.

However, when diseases that increase the operative risk, such as cardiac or pulmonary disorders, are present there is little reason not to manage "silent" gall stones conservatively.

On the other hand, more cautious physicians recommended that all asymptomatic patients be treated medically unless symptoms supervene.

Diabetics present a special case, because acute cholecystitis in these patients carries a high risk of serious complications, and cholecystectomy during the acute disease is far more dangerous than elective surgery.

Medical treatment of gallstones has now become a possibility. Oral intake of a bile acid, chenodeoxycholic acid or taurocholic acid , and percutaneous instillation of cholesterol solvent into the gallbladder have dissolved radiologically documented gallstones. Lithotripsy has also been used.

Most of the complications of cholelithiasis relate to the obstruction of the cystic duct or common bile duct by stones.

Passage of stone into cystic duct often, but not invariably, cause severe biliary colic and may lead to acute cholecystitis.

Repeated episodes of acute cholecystitis may lead to chronic cholecystitis.

The latter condition can also result from the presence of stones alone.

Gallstones may pass into the common bile duct (choledocholithiasis), where they lead to obstructive jaundice, cholangitis, and pancreatitis.

In populations where alcoholism is not a factor, gallstones are the most common cause of acute pancreatitis.

Passage of a large gallstone into the small intestine may cause intestinal obstruction, a condition called gallstone ileus.

In obstruction of the cystic duct, with or without acute cholecystitis, the bile in the gallbladder is reabsorbed, to be replaced by a clear mucinous fluid secreted by the gallbladder epithelium.

The term hydrops of the gall bladder (mucocele) is applied to the distended and palpable gallbladder, which may become secondarily infected.

 Visit:  Cholesterol stone : click here ;Pigment stones (calcium bilirubinate); "Mixed" stones

 

Further reading:

Risk-factors of cholelithiasis and chronic cholecystitis during pregnancy  

Inflammatory diseases of the gall bladder and biliary system.

Cholelithiasis and cholecystitis.

Histopathological changes in gallbladder mucosa in cholelithiasis: correlation with chemical composition of gallstones.

Pathogenesis of gallstones.

Silent gallstones: a therapeutic dilemma.

Asymptomatic cholelithiasis revisited.

Cholelithiasis in childhood. Proposals based on a muticentric study.

Management of asymptomatic lithiasis .

Gallbladder wall inflammatory cells in pediatric patients with biliary dyskinesia and cholelithiasis: a pilot study.

Neoplasms and dysplasias of the gallbladder and their relationship with lithiasis. A case control clinicopathological study.

 

 

          

 

 

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