Calcium bilirubin stones
Introduction
Introduction In addition to bilirubin, bilirubin calcium stones contain a small amount of calcium salts and organic matter (bacteria, eggs or epithelial cells). Stones can be found in the common bile duct, but also in the intrahepatic and extrahepatic bile duct systems, but rarely in the gallbladder.
Cause
Cause
1. Infection: Biliary infection is the main cause of the formation of bilirubin calcium stones. At the time of infection, the bacteria in the biliary tract release -glucuronidase, which hydrolyzes the bound bilirubin to glucuronic acid, and the free bilirubin combines with the calcium salt to precipitate. Under normal circumstances, although the bile contains -glucuronidase, the content is relatively small, and there are also antagonists such as glucose 1,4-spirolactone, so the enzyme activity is not exhibited. However, when the biliary tract infection occurs, not only the -glucuronidase activity in the bile increases, but also the Escherichia coli, Bacteroides, and Clostridium infection can produce a large amount of -glucuronidase. Thus, the increase in the amount of -glucuronidase and the increase in activity can hydrolyze a large amount of bound bilirubin to form free bilirubin, which is insoluble in water, and combines with calcium in bile to form insoluble bilirubin. Calcium particles. The bilirubin calcium granules are mainly composed of erythrocytes and parasitic eggs, and are continuously deposited with the help of mucin in the bile to form stones.
Furthermore, bacterial infection can cause inflammation of the gallbladder, thickening of the gallbladder wall, decreased gallbladder function, and prolonged storage of bile in the gallbladder, thereby accelerating the formation of stones. In addition, IgA deficiency (a lack of antibodies in the human body) can reduce the immune function of the gallbladder and increase the chance of infection and stone formation.
2. Biliary tsutsugamushi disease: biliary ascariasis is the main cause of bile duct stones in China. In addition, liver fluke and flagellosis can also cause damage to the biliary tract and cause biliary infection. In addition, the debris and eggs of the worm can form the core of the stone and become the formation condition of the primary bile duct stone.
3. Bile composition changes: bile acids can prevent or reduce the precipitation of bilirubin calcium, and glycoproteins can easily become a scaffold for stones.
4. Oxygen free radicals: Oxygen free radicals can accelerate the formation of bilirubin calcium and secrete more glycoproteins in gallbladder epithelial cells, which is conducive to the formation of gallstones.
5. Diet: Long-term malnutrition can not only affect the normal defense ability of the biliary tract, but also a low-fat, low-protein, high-carbohydrate diet, which can reduce the amount of glucose dilactone in the bile and inhibit the action of -glucuronidase. Attenuated, the activity of -glucuronidase is enhanced, and bilirubin is easily precipitated to form biliary pigment stones.
6. Congenital abnormalities of the biliary system: Gallstones caused by anatomical variations of the bile duct system are prone to gallstones in this part. It is important to note that malnutrition is common in patients with pigment stones.
Examine
an examination
Related inspection
Indirect bilirubin gallbladder ultrasound laparoscopic
Its characteristics are: the stones are muddy or blocky, and some large stones are shaped to be consistent with the dilated bile duct. Most of the stones are brownish yellow or brownish black, loose and brittle. The occurrence of stones is closely related to diet structure, health habits, biliary infections, and biliary mites. The incidence rate is higher in young adults, and some clinical symptoms often date back to childhood. The disease is chronic and progressive, seriously jeopardizing the health of the working people.
Diagnosis
Differential diagnosis
Differential diagnosis of bilirubin calcium stones:
Compared with bilirubin calcium stones, melanin stones are rare, but most occur in the gallbladder, which is a pathological stone. The stones that are complicated by hemolytic disease or cirrhosis are almost all melanin stones. Unlike bilirubin calcium stones, melanin stones have no bacterial infections around the bile.
