Types of Gallstones and Causes of Development
Types
As a general rule of stone formation, they have the basic processes of precipitation, precipitation, nucleation and accumulation growth of bile components. The pathogenesis includes several elements. First, the bile must be supersaturated with cholesterol or calcium; second, the solute must nucleate and precipitate as solid crystals from the solution; third, the crystals must aggregate and fuse to form stones, and the crystals grow and collect in the mucus and gel spread throughout the gallbladder wall, and the gallbladder evacuation is impaired to facilitate the formation of gallstones. There are two major categories of stones in terms of their composition and structure.
Cholesterol stones
The basis of cholesterol stone formation is an imbalance in the ratio of cholesterol, bile acids, and lecithin in the bile, resulting in crystallization, precipitation, aggregation, and stone formation in the bile in a supersaturated state. Most of the cholesterol in bile originates from the biosynthesis of hepatocytes rather than from the secretion of cholesterol from the diet. The formation of cholesterol stones is mainly due to the supersaturation of cholesterol in the bile synthesized by hepatocytes and the nucleation of cholesterol crystals by proteins in the bile, while other factors are attributed to the impairment of the motor function of the gallbladder, which act together to stagnate the bile and promote the formation of gallstones.
In addition, some studies have shown that changes in prostaglandin synthesis in the gallbladder and high calcium concentrations in the bile may also contribute to gallstone formation. In some patients, the prerequisite for gallstone formation is bile sludge production. The so-called bile sludge is composed of stagnant glycoproteins containing cholesterol crystals. This bile sludge can be detected on ultrasound and may be the only abnormality detected on ancillary testing in patients with biliary colic, pancreatitis or cholangitis.
Bile Pigment Stones
There are two types of bile pigment stones: black stones and brown stones. Black stones form primarily in the gallbladder in patients with hepatic sclerosis or chronic hemolytic disease, while brown stones can form in both the gallbladder and the bile duct. Bacterial infection is the main cause of primary bile duct stone formation. Primary bile duct stones are common in Asia, and the source of infection may be attributed to parasites such as Schistosoma chinensis or other less clear causes.
Causes of disease
1. Preferring to be quiet and less active
Many patients, especially women, tend to spend more time at home and less time exercising and doing physical work, which inevitably decreases the contraction force of their gallbladder muscle and delays the emptying of bile, easily causing bile stasis and cholesterol crystals to precipitate, creating conditions for the formation of gallstones. In addition, the high level of estrogen in women affects the formation of glucuronide bilirubin in the liver, which increases non-conjugated bilirubin, and estrogen affects the emptying of the gallbladder, causing stagnation of bile and sweat and promoting the formation of stones. The incidence of gallstones increases significantly in those who use estrogen after menopause.
2, physical obesity
Many people usually love to eat high-fat, high-sugar, high cholesterol drinks or snacks, the direct result of this hobby is the body fat, and obesity is an important basis for the development of gallstones. Research shows that people who weigh more than 15% of the normal standard, the incidence of gallstones is 5 times higher than normal. 40 years old and above fat women, is the highest incidence of gallstones, at this time, female estrogen will make more cholesterol gathered in the bile.
3, do not eat breakfast
I am afraid that more modern people do not eat breakfast than eat breakfast, and long-term skipping breakfast will increase the concentration of bile, which is conducive to the reproduction of bacteria and easy to promote the formation of gallstones. If you insist on eating breakfast, you can promote the flow of some bile, reduce the viscosity of the stored bile overnight, reducing the risk of gallstones.
4.Multiple pregnancies
During pregnancy, the biliary tract function of women is easily disturbed, resulting in weak contraction of smooth muscle and retention of bile in the gallbladder, coupled with the relatively high cholesterol in the blood during pregnancy, which is prone to precipitation, the chance of forming gallstones is greatly increased, and the incidence is higher in women with multiple births.
5.After meal snack
Now many families in China can see the situation, the family after dinner, sitting leisurely on the sofa, while eating snacks and chatting while watching TV. This habit of sitting and snacking after meals may be one of the reasons for the high incidence of gallstones in China. When a person is in a curled position, the intra-abdominal pressure increases, the gastrointestinal tract peristalsis is restricted, which is not conducive to the digestion and absorption of food and bile excretion, sitting after a meal hinders the reabsorption of bile acids, resulting in an imbalance in the ratio of cholesterol to bile acids in bile, cholesterol is easy to deposit.
6.Patients with cirrhosis of the liver
This is related to the decrease of estrogen inactivation function in the body of patients with cirrhosis, and the higher level of estrogen in the body, coupled with the low contraction function of the gallbladder in cirrhosis, poor emptying of the gallbladder, varicose veins of the bile duct, and elevated bilirubin in the blood and other factors can cause gallstones.
7, genetic factors
Genetic factors obviously play an important role in defining the risk of gallstones. Gallstones are more frequently produced in close relatives of patients with cholesterol cholelithiasis. The fact that local Americans in the southwestern United States have a high risk of cholesterol gallstone disease (>80%) appears to include a genetic factor.