Pigment stones: these are usually black stones but many be brown as well. The stones are usually calcified. The calcification is usually centrally located.
The stones are associated with hemolysis, cirrhosis and elderly patients. Thirty percent of stones in United States are pigmented stones. These are usually black stones.
Risk factors for pigmented stones:
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Age: present usually in patients who are the 6th to 7th decade of life. |
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Infection with Clonorchis sinensis. |
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Infection with Ascaris lumbricoides. |
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Biliary stasis. |
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Sphincter of Oddi spasm (usually associated with opiate use). |
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E. Coli infections. E. Coli infection reduces the pH of the bile ducts and allows for gallstone formation. |
Clinical presentation:
One-third of patients with gallstones have no symptoms. Approximately one-third experience mild symptoms. 1/5 of patients have serious complications associated with a gallstone disease. These complications consist of the following:
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Acute cholecystitis. |
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Sepsis (infection of the blood due to bacteria derived from the bile ducts). |
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Cholangitis (infection in the common bile duct). |
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Peritonitis (infection in the peritoneal cavity). |
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Fistulous formation (abnormal tubular connections between various parts of the GI tract). |
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Gallstone ileus. |
Biliary colic is the term used to describe pain associated with symptomatic gallstones. This pain usually occurs after heavy meals. It is usually located in the right upper quadrant and may radiate to the epigastrium, back and shoulder blades. The pain may last for 1 to 6 hours. It may be mild or severe. Most patients experience nausea and vomiting.
Other conditions that may present in a similar fashion include the following:
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Myocardial infarct. |
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Ruptured aortic aneurysm. |
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Perforated peptic ulcer. |
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Pneumonia. |
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Pneumothorax. |
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Pleurisy. |
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Intestinal obstruction. |
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Intestinal ischemia. |
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Pancreatitis. |
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Renal colic. |
Evaluation of this condition includes an ultrasound, liver function tests, amylase, lipase, complete blood count, urinalysis and electrolytes. An oral cholecystogram helps to visualize the gallbladder. However, it is not as sensitive as ultrasound. CT scan may also be used in patients with difficult or complicated cases.
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Other Liver Pages:
- Acute Acalculus Cholecystitis |
Acute Calculus Cholecystitis |
Albumin |
Alcoholic Cirrhosis |
Alcoholic Liver Disease |
Alpha 1 Antitrysin Deficiency |
Autoimmune Hepatitis |
Bilirubin |
Common Bile Duct Stones |
Esophageal Varices |
Gallstones |
Hemochromatosis |
Hepatitis G Virus |
Hepatitis - General |
Hepatitis A |
Hepatitis B |
Hepatitis C |
Hepatitis D |
Hepatitis E |
Iron Overload Diseases |
Primary Biliary Cholangitis |
Primary Sclerosing Cholangitis |
Wilson's Disease
Related Links
- Definitions |
Liver Function Tests
Patient Education:
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