Pigment gallstone composition in patients with hemolysis or infection/stasis

Abstract

The effect of hemolysis and infection/stasis on pigment gallstones was assessed by comparing the composition of stones from (1) U.S. patients without hemolysis or cirrhosis, (2) U.S. patients with sickle cell disease, and (3) Japanese patients with biliary infections. Gallstone composition was quantitated by infrared spectroscopy and chemical analyses. Gallstones from patients with sickle cell anemia contained more pigment, carbonate, calcium, and measured components than stones from U.S. patients without hemolysis (P less than 0.05). However, the similar types of calcium salts in black stones from patients with and without sickle cell anemia suggested that intermittent hemolysis may be a potential mechanism in the formation of black stones found in the general population. In Japanese patients with brown pigment stones, there was an absence of calcium carbonate, low levels of calcium phosphate, and the presence of calcium salts of fatty acids (P less than 0.05). Thus, the accompanying stasis and/or infection in this latter group was associated with the formation of a distinctive stone type and was not involved in the formation of the black stones. The similarly small proportion of cholesterol in each of these groups suggested that it was present due to coprecipitation rather than to cholesterol supersaturation.

Gallstone Classification in Western Countries

“…Gallstones were analyzed with x-ray diffractometry (Siemens D500 diffractometer), infrared spectroscopy (PerkinElmer 357 infrared spectroscopy), and scanning electron microscopy (ISI SS40 scanning electron microscope) ( Table 1). Identification of the various compounds was done by comparing the observed spectra and diffraction angles with those reported in the literature [11,[14][15][16]. In addition, in a subgroup of patients with gallbladder adenomyomatosis (increase in depth and number of Rokitansky-Aschoff sinuses), scanning electron microscopy of the gallbladder wall was done [17].…”

“…Gallstone prevalence in adult population ranges from 10 to 15 % [5]. Gallstones in Western countries are distinguished into the following classes: cholesterol gallstones that contain more than 50 % of cholesterol (nearly 75-80 % of gallstones) and pigment gallstones that contain less than 30 % of cholesterol by weight, which can be subdivided into black pigment gallstones (10-15 %) and brown pigment gallstones (5-10 %) [6][7][8][9][10][11] (Fig. 1).…”

Fasciola hepatica : lithogenic capacity in experimentally infested rats and chemical determination of the main stone components

“…However, from the MS data we could not deduce the precise ratio of the two components in the samples, since an m/z 256 peak was present in the mass spectra of pure palmitic and stearic acids. Infrared (IR) spectroscopy is likewise of little utility for this purpose as it does not allow the unambiguous dierentiation of signals from each fatty acid in a mixture of both (Soloway et al 1986).…”

Structure and Composition of Common Bile Duct Stones in Relation to Duodenal Diverticula, Gastric Resection, Cholecystectomy and Infection

“…), of the stones were compared with those of 1 mg pure cholesterol (Sigma, St. Louis, Mo., USA) or bilirubinate [5]. For analysis of cholesterol content a wavelength of 1,055 cm –1 and for bilirubinate wavelengths of 1,662 and 1,622 cm –1 were chosen for quantitation [4, 6]as previously reported [1]. …”

“…Varying cutoff values for stone type have been used, but most groups agree that stones with more than 50% cholesterol content are cholesterol stones [2, 4, 5], whereas stones with less than 50% cholesterol are of the pigment type. Pigment stones are either black, consisting of bilirubin polymers, with the possible result of bilirubin load exceeding the conjugating capacity of the liver, or brown made up of calcium bilirubinate and associated with stasis and biliary infection [6, 7]. Occasionally stones are drug-derived [8]or consist of inorganic salts like calcium carbonate.…”