Pigmented gallstones
Introduction
Introduction In the United States, pigmented stones account for about 20% to 30%; while in Taiwan, most of these stones are estimated to be more than 60%, but in recent years, control of chronic liver disease, reduction of parasitic diseases, and improvement of the sanitation environment, This pigmented stone has a significant decreasing trend. The formation of pigmented gallstones is closely related to the insoluble concentrations of bilirubin, bile salt reduction, biliary tract infection, gallbladder relaxation, primary liver disease, hemolytic disease and aging.
Cause
Cause
1. Infection: Over the years it has been thought that infections of the biliary system are associated with the formation of gallstones, especially pigmented stones. Clinically, we often have a relationship between biliary ascariasis and gallstone formation. Many nucleus of pigmented stones are normal mites or eggs.
2. Dietary factors: Many theories and practices have shown that excessive cholesterol intake in the diet is associated with gallstone formation. Low-protein and low-fat dieters are more susceptible to bile pigmented stones than high-fat dieters, possibly by altering bile components, especially bile acids.
3. Liver disease and hemolytic disease: Clinical practice has confirmed that cirrhosis, especially alcoholic, is prone to bilirubin calcium and calcium carbonate stones. In hemolytic anemia, due to an increase in -glucuronidase produced from the gallbladder epithelium or hepatocytes, an increase in bilirubinase hydrolysis results in the production of a large amount of unbound bilirubin in the gallbladder, resulting in the formation of black stones.
4. Age and gender: According to clinical practice, there was no significant difference in the incidence of bile pigment stones between the two sexes. Its incidence seems to be related to age, that is, its incidence increases with age, and the reason is not very clear.
5. Bile retention: Any cause of bile retention in the biliary system can be beneficial for the occurrence of biliary calculi, such as surgical or inflammatory biliary (intrahepatic or extraluminal) stenosis, Oddi's sphincter dysfunction, and lack of Nipple stenosis can cause cholestasis, which is conducive to the formation of infection and biliary pigment stones.
6. Viscosity and changes in bile: According to some research results, the viscosity and value of bile and bile in the bile pigment stones are lower than those in normal, indicating that bilirubin is combined with calcium to form bilirubin calcium. It is only necessary to provide the necessary conditions for the stone.
Examine
an examination
Related inspection
Gallbladder ultrasound cholangiography
In addition to clinical manifestations, abdominal ultrasound is the most convenient and highly accurate (greater than 95%) diagnostic tool, of course, computed tomography, retrograde cholangiopancreatography also has a good diagnostic rate, but less Convenient for the economy, the patient is also uncomfortable. As for the previous oral and venous cholecystography, it has been used less because of its accuracy and specificity.
Diagnosis
Differential diagnosis
Bilirubin Calcium Stone: The main component of bilirubin calcium stone, in addition to bilirubin, also contains a small amount of calcium salts and organic matter (bacteria, eggs or epithelial cells. Stones can exist in the common bile duct, but also in the intrahepatic and extrahepatic bile ducts System, but rarely occurs in the gallbladder.
Static calculus: A resting stone is a gallstone that has no pain relative to the resting phase or has been relieved of pain after treatment, as opposed to a symptomatic active calculus.
In addition to clinical manifestations, abdominal ultrasound is the most convenient and highly accurate (greater than 95%) diagnostic tool, of course, computed tomography, retrograde cholangiopancreatography also has a good diagnostic rate, but less Convenient for the economy, the patient is also uncomfortable. As for the previous oral and venous cholecystography, it has been used less because of its accuracy and specificity.
