Gallstones and Gallbladder Disease - Introduction

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Formation of Gallstones (Cholelithiasis)

Gallstones can range from a few millimeters to several centimeters in diameter. Most are formed from cholesterol. Pigments stones are the second most common type of gallstones (approximately 15% of stones are pigment stones). Patients can also have mixture of these two. Pigment stones are formed from a brown-colored substance called calcium bilirubinate.

Cholesterol Stones. Although cholesterol makes up only 5% of bile, about three-quarters of the gallstones found in the US population are formed from this substance. Cholesterol gallstones typically form in the following way:

• Cholesterol is not very soluble, so in order to remain suspended in fluid it must be transported within clusters of bile salts called micelles. If there is an imbalance between these bile salts and cholesterol, then the bile fluid turns to sludge. This thickened fluid consists of a mucus gel containing cholesterol and calcium bilirubinate.
• If the imbalance worsens, cholesterol crystals form (called supersaturation), which can eventually form gallstones.
• This process of gallstone formation is referred to as cholelithiasis. It is very slow and most often painless.

Click the icon to see an image of gallstones.

Supersaturation and cholelithiasis can occur as a result of various abnormalities, although the cause is not entirely clear. There are many events that may promote cholelithiasis.

• The liver secretes too much cholesterol into the bile.
• The gallbladder may not be able to empty normally, so that the bile becomes stagnant.
• The cells lining the gallbladder may not be able to absorb cholesterol and fat from bile efficiently.
• High levels of bilirubin have been observed in patients with gallstones. Bilirubin is a substance normally formed by the breakdown of hemoglobin in the blood and it is excreted in bile. Some experts believe it may play an important role in cholesterol gallstones.

Pigment Stones. Pigment stones are composed of calcium bilirubinate, or calcified bilirubin. Pigment stones can be black or brown.