The distribution of calcium salt precipitates in the core, periphery and shell of cholesterol, black pigment and brown pigment gallstones

Abstract

Calcium bilirubinate, palmitate, carbonate and phosphate have been identified in the cores of cholesterol and pigment gallstones, suggesting a role for precipitated calcium salts in the early events of gallstone formation. Previous studies that compared the calcium salt contents of cholesterol and pigment stones required destruction of gallstone structure. We have used scanning electron microscopy with windowless energy-dispersive x-ray microanalysis to determine the prevalence of calcium salts in a series of cholesterol (n = 105), black pigment (n = 35) and brown pigment (n = 6) gallstones obtained from 146 consecutive patients undergoing cholecystectomy. These techniques provide specific identification of cholesterol and individual calcium salts as they occur within the core, periphery and shell of gallstones without destroying stone structure. Calcium precipitates more than 0.5 micron in diameter can be detected in a cholesterol background at a detection limit of 0.01% by weight. Calcium salts were detected in the centers of 88% of cholesterol and 100% of black (p < 0.05 vs. cholesterol) and brown pigment stones. Calcium bilirubinate was identified in the cores of 54% of cholesterol and in all pigment stones (p < 0.001 black pigment vs. cholesterol). Calcium palmitate was detected in all brown pigment stones, in 39% of cholesterol stones (p < 0.001 vs. brown pigment) and in 31% of black stones (p < 0.01 vs. brown pigment). Peripheral calcium salts were detected less in cholesterol (19%) than in black or brown stones (100%, p < 0.05). Fourteen percent of cholesterol and black pigment stones were surrounded by shells containing mostly calcium carbonate.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholelithiasis and the Risk of Nephrolithiasis

“…23, 28 For example, aquaporins likely play an important role in water transport across human gallbladder epithelium. 28 Because higher bile calcium concentrations are a risk factor for pigment gallstones (and also may play a role in the pathogenesis of cholesterol gallstones), 23, 29,30 it is intriguing to consider the possibility of an unknown “channelopathy” that increases calcium content in both bile and urine.…”

Fixed‐point and stratified analysis of the fine structure and composition of five gallstones with Fourier transform infrared (FT‐IR) specular reflection spectroscopy

“…The content and distribution of a gallstone's components can provide information on the pathophysiological process of gallstone formation. Because of the limited means of examining gallstones, previous studies could not accurately depict the three‐dimensional spatial distribution of gallstone components (Diehl et al,1995; Kaufman et al,1994; Rautray et al,2006; Schafmayer et al,2006; Wang et al,2010; Yoo et al,2008). In our study, the conflict between positioning analysis and qualitative detection in sample preparation was avoided by using Fourier transform infrared specular reflection spectroscopy combined with micron‐scale microscopy.…”

Calcium carbonate gallstones in children

“…Nevertheless, 2 (4%) of our adult patients had calcium carbonate stones. In American adults, calcium carbonate is found in small quantities (≤20% weight) in up to 20% of cholesterol and pigment gallstones [10][11][12][13]. These small amounts of calcium carbonate are more frequently found in the peripheral layers of cholesterol gallstones [10,14], supporting the concept that calcium carbonate precipitation more commonly occurs during intermittent obstruction of the cystic duct by a cholesterol stone than at stone nidation.…”

“…Kaufman et al [13] found no calcium carbonate gallstones among 146 consecutive adults undergoing cholecystectomy at the Johns Hopkins Hospital, Baltimore, MD. In a previous study of gallbladder stones from 50 adults from Galveston, Texas, all were found to be cholesterol stones; none contained more than 20% calcium carbonate (Soloway and Taylor, unpublished observations).…”