Cholesterol Stones Research Articles

A Prospective Observational Study of Clinicopathological and Biochemical Profile of Patients with Cholecystitis Visiting a Teaching Tertiary Care Centre of Haryana

Abstract Introduction Gallstone diseases constitute a major part of patients visiting hospitals, and more than 50% of operation theaters are occupied by it or diseases related to it. It also imposes significant financial burden on health resources. The 21st century has opened with an improved foundation to our understanding of the basis of bile formation by defining the key transporters of the lipids in bile and the responsible genes. The specter of obesity as an epidemic in developed countries, and the recent recognition of the metabolic syndromes and their links to gallstone formation, emphasize the expectation of a rise in the frequency of cholesterol cholelithiasis. Materials and Methods Data pertaining to patients who were admitted/received surgery for a diagnosis of gallstone diseases at the Department of General Surgery of BPS GMC Khanpur Kalan was collected.The collected data was entered in a Microsoft Excel spreadsheet. Mean ± standard deviation (SD) was calculated for quantitative data, using Student’s “t” test/Kruskal test. Chi-square test was used to find out the association for categorical data. Results and Discussion Most of the patients were experiencing right hypochondriac pain (79.23%) as presenting complaints, with the most common age range being 31 to 40 years, followed by 41 to 50 years, that is, 31.85% and 20.74%, respectively. Females were most commonly affected, approximately 90%, and only 10% of patients with gallstones visiting our hospital were males. Maximum patients had chronic cholecystitis (80%) on histopathological examination, followed by cholesterosis (6.15%). As much as 82.6% of patients presented with mixed gallstones, followed by cholesterol stones, that is, 10.43%. All types of stones are more common in patients with abdominal adiposities, that is, having waist-to-hip ratio more than 0.85, and these findings are statistically significant. Conclusion Our study concluded that gallstones were more common in females of younger population (31–40 years) with right hypochondriac pain as presenting complaints. The most common histopathology was chronic cholecystitis with mixed types of stones, which is associated with increased waist-to-hip ratio. All biochemical markers were within normal range.

Thyroid function and gallstone disease: is there an association?

Gallstone disease, amounts to a significant amount of disease burden to the medical society, more commonly encountered in the West. Various predisposing factors are associated with the development of cholelithiasis, namely age, gender, dietary food habits and haemolytic conditions, but whether or not thyroid dysfunction is a causative factor, till date, is a subject of dispute. Gallstones can be classified into cholesterol stones and pigment stones which are black or brown (with cholesterol) in colour. Thyroid hormones are said to have a direct effect on the sphincter of oddi, thereby aiding in biliary emptying. They also alter the lipid metabolism which is said to cause supersaturation of cholesterol in bile, and hence result in the formation of cholesterol stones. Several studies have tried to establish this hypothesis and have concluded with diversified results. This review article throws light into the concept of the association between thyroid dysfunction and formation of gallstones by evaluating several articles through a systematic approach in order to arrive at a better consensus.

Porcelain gallbladder and its relationship to cancer

Summary Background Porcelain gallbladder (PGB) is defined as calcium deposits encrusting the internal visceral layer, which becomes hard, brittle, and bluish. Porcelain gallbladder is rare and has been found in less than 1% of routine cholecystectomy specimens. Several studies report an incidence of gallbladder carcinoma (GBC) associated with gallbladder calcification varying between 12.5 and 61%, data which have been known for 60 years. There is a lack of information concerning PGB and its association with GBC, and the aim of this study is to better define this relationship. Methods A total of 10 patients were found to have PGB in 1050 consecutive routine surgical cholecystectomies. Clinical and laboratory findings, gallbladder histologic examination, bile culture, and bile pH were related to stone composition analysis performed by X‑ray diffraction using Perkin–Elmer (Perkin Elmer Corp. Norwalk, CT, US) 1625 FTIR. Results Among the 10 patients with PGB, complete calcification of the entire gallbladder wall was present in six cases, while four patients had partial calcification. Gallstones were present in all cases of PGB, multiple stones in nine cases and a single stone in one case. Bile culture was performed in all patients of the series. Among the 10 cases with PGB, culture was positive in two cases. Conclusion PGB is a disease as rare as it is subtle. Moreover, the chronic stimulation by stones can generate an initial dysplasia that will subsequently turn into a neoplasm: the cancerization risk is probably no different from long-standing cholesterol or combined stones, but as risk factor for cancer it requires early cholecystectomy.

A computer study of the risk of cholesterol gallstone associated with obesity and normal weight

Obese people differ from the people of normal weight in gall bladder motility and have a higher risk of cholesterol stone formation. In this study, using a mathematical model of cholesterol homeostasis, which also considers the enterohepatic circulation of bile as well as cholesterol, we investigated the risk of cholesterol stone formation in obese and normal-weight groups who had normal blood cholesterol levels. We associated the risk of stone formation with the amount of cholesterol released into bile and the amount of de novo-synthesized cholic acid. For both groups, we determined the conditions of low and high risk. In addition, we analyzed the potential effects of changes in gall bladder motility with increased weight. The results showed that the obese group exhibited increased kinetics of enterohepatic circulation, leading to a significant increase in blood cholesterol levels, which can be reduced by increasing the amount of cholesterol in bile. Based on this finding, we suggest that for obese people, it is beneficial to reduce the amount and change the composition of circulating bile through the inhibition of cholic acid synthesis along with cholesterol synthesis. Furthermore, obese people should maintain a triglyceride-lowering diet and consume small meals containing fat, preferably in combination with agents that can reduce bile output from the gall bladder.

English

BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive imaging method of demonstration of hepatic, cholangio- and pancreatic-systems and their duct system and depends on heavy T2-weighted (T2-W) images. The present study was undertaken to study and evaluate patients with clinical suspicion of the biliary tract, gall bladder and pancreatic pathology, with conventional magnetic resonance imaging (MRI) and MRCP and to assess the pitfalls in MRCP for the evaluation of the biliary tract, gall bladder, and pancreas. METHODS The study included sixty patients with clinical signs and symptoms of obstructive jaundice referred for MRCP to the Department of Radiodiagnosis at Katuri Medical College and Hospital and patients who were referred to the department with clinical suspicion of pancreas, gallbladder and biliary tract disease. Pregnant patients, claustrophobic patients and patients with MRI contraindications such as cardiac pacemakers, aneurysm clips and metallic implants were excluded from the study. RESULTS Most of the patients in our study were of 30 - 70 years age group. Of the sixty cases included in our study, 58 % were males and 42 % were females. In most of the patients, in our study, benign pathology was observed which included cholelithiasis and choledocholithiasis and acute pancreatitis being next common. Case of choledochal cyst were also encountered. Most of common bile duct strictures were of benign aetiology. Of the malignant pathology detected, cholangiocarcinoma followed by periampullary carcinoma and gallbladder carcinoma were commonly encountered. CONCLUSIONS Magnetic resonance pancreatic cholangiography is an imaging modality for evaluation of pancreaticobiliary disorders. MRCP detected the exact location and cause of biliary tract obstruction and aetiology was well demonstrated. Pure cholesterol stones are difficult to detect on CT because they are iso attenuating or slightly hypoattenuating to bile. Sub centimetric calculi are well demonstrated by MRCP. Malignant strictures and benign strictures are well demonstrated. MRCP being non-invasive and radiation hazard free with inherent high resolution with multiplanar imaging capability could be considered as gold standard in imaging of few gall bladder and biliary system disorders. KEYWORDS Magnetic Resonance Cholangiopancreatography, Cholelithiasis, Pancreatitis, Periampullary Carcinoma, Gall Bladder Carcinoma, Cholangiocarcinoma

Relationship of gallbladder histopathology towards types of stones in cholelithiasis patients at Universitas Sumatera Utara Hospital, Medan, Indonesia

Background: Cholelithiasis is a common disease of the gall bladder. It is estimated that around 10-15% of the population in western countries suffer from cholelithiasis. Types of gall bladder stones can be classified into cholesterol stones (containing cholesterol> 50%), mixed stones (containing 20-50% cholesterol), and pigment stones (containing cholesterol <20%). Cholelithiasis causes various histopathological changes in the gallbladder mucosa such as acute and chronic inflammation, Cholelithiasis, hyperplasia and carcinoma. The general objective of this study was to determine the histopathological relationship of the gallbladder to the type of stone in cholelithiasis patients at USU Hospital.Method: The design in this study was cross-sectional. The sample of this study was 49 samples of patients with cholelithiasis who underwent cholecystectomy either by open cholecystectomy or per-laparoscopic cholecystectomy at Universitas Sumatera Utara (USU) Hospital. Gallstones and gall bladder will be examined in the laboratory. Data analysis will use the chi-square test. Result: From 49 research samples found the most types of stones were mixed stones with 24 (49%) and histopathological results showed 18 examples (36.7%) were chronic inflammation. Based on the Chi-Square test found a significant relationship between the types of stones with histopathology of the gallbladder with a p-value of 0.001. Conclusion: There is a significant relationship between the type of stone with histopathology in patients with cholelithiasis.Â

Cholesterol Hepatolithiasis Detection with Dual Spectral CT

Introduction: Hepatolithiaisis with cholesterol stones can sometimes be difficult to diagnose in a dilated biliary system with standard CT abdomen. Dual Spectral CT reconstruction can allow better visualisation of stones including cholesterol stones.

Incidence of Microflora from Cultures of Gall Bladder Bile of Laparoscopic Cholecystectomy

Background: Gallstone disease is one of the most common problem affecting the digestive tract. Through experience it has been accepted that bile in normal conditions remains sterile. Bactibilia is a common finding in individuals at high risk or with complicated cholecystolithiasis, however few data prevails about the prevalence of bactibilia in patients operated on for uncomplicated laparoscopic cholecystectomy. There is a common usage of preoperative and postoperative antibiotics in the different patients without the existence of any actual bacteriologic and epidemiologic evidence. Material and methods: 222 patients with diagnosis of cholecystolithiasis postoperated of laparoscopic cholecystectomy had a bile sent to bacteriology. Bile was aspirated from the gall bladder during laparoscopic cholecystectomy. Results: Bactibilia was identified in 50 (23%) of the cultures of mild chronic cholecystitis. A total of 172 negative cultures were obtained (77) and 50 positive (23%). In the present study out of 50 patients, 32 (64%) were females and 18 (36%) were males. We found total of 25 (50%) black pigmented stones, 15 (30%) were brown and 10 (20%) were cholesterol stones. In this study bile culture was showing growth of the following organisms. The commonest organism was Enterococcus (32%) followed by E. coli (26%), Klebsiella (14%). Conclusions: Bactibilia has long been known to be associated with biliary tract diseases and culturable bacteria in bile can represent a state of asymptomatic bactibilia which can disseminate after any intervention causing infective complication. Exploring the microflora of gall bladder bile important role in choosing the appropriate antibiotic to prevent complication.

A Cross-sectional Study to Estimate the Prevalence of Dyslipidaemia in Patients with Cholelithiasis

Introduction: Gallstones are one among the common gastrointestinal illness requiring hospitalisation and frequently occur in middle- aged otherwise healthy people with a prevalence of 10 to 15%. Women are more frequently affected than men. Most patients remain asymptomatic from their gallstones and remain silent throughout life. One major factor contributing to cholesterol stone formation is high concentration of cholesterol and lipids in bile secretion from liver. Changes in human behaviour and lifestyle over the last few decades have resulted in a dramatic increase in the incidence of dyslipidaemia and gallstone disease worldwide. Aim: To estimate the prevalence of dyslipidaemia in patients with gallstones. Materials and Methods: A cross-sectional study was done on 82 patients who were admitted in a tertiary care centre with gall stone confirmed by ultrasound abdomen, during the period between November 2016 to October 2017. Patients with dyslipidaemia taking medicine were excluded. Data were entered in structured data sheet which includes all the variables and results were expressed in frequency and percentage. Results: Forty-two patients were found to have dyslipidaemia and the prevalence was found to be 51.2%. Maximum prevalence of cholelithiasis was found in the 41-50 years age group (58.5%). Fifty-six were females (68.3%). Twenty-four patients had very high Serum Low Density Lipoprotiens (LDL) levels. Twenty-three had high levels of Triglycerides (TG) (28%). Six had very low High Density Lipoprotein (HDL) level (7.3%). Conclusion: The prevalence of dyslipidaemia estimated was 51.2%. Of the fractions of serum lipids, the LDL and triglycerides level elevations was more commonly detected in patients with gall stone.

A South Indian Cadaveric Study on the Prevalence of Gallstones

Background Gallstone disease (GSD) is one among the most prevalent diseases that affects approximately 10-15% of the population. It is associated with many other diseases like gallbladder cancer, renal stones, atherosclerosis, coronary heart disease and stroke. Objective Objective of this study is to document the prevalence of gallstones among south Indian cadavers. Method One hundred and twenty three South Indian cadaveric livers/gallbladders were observed for the presence of gallstones. The age range was 40 to 70 years. The gallbladders were palpated to know the presence of stones. They were then dissected and the stones were classified based on appearance. Gall bladder walls were also observed to know the associated fibrosis. Result Among the cadavers studied, 0.81% possessed cholesterol stones and 4.06% had pigment stones. Among the stones, 83.33% were pigment stones and 16.66% were cholesterol stones. Conclusion Compared to the western countries and north Indian studies, the prevalence of gallstone diseaseis low in the south Indian population (4.87%). The low prevalence was probably due to the low socioeconomic status and the diet and lifestyle.

Morphological spectrum of gallstone and bacteriology of bile in patient of cholelithiasis visiting tertiary care centre in North India

Background: Calculus biliary tract disease continues to be a major health concern. It is normal to see predisposing factors such as cirrhosis, ileal resection in the West; while infection predominates in South East Asia as a cause. We prospectively examined gall stones in this study to investigate the causes and role of bacteria in the disease of gall stone disease.Methods: This is a cross sectional study conducted in department of surgery, Sri Guru Ram Das University of Health Sciences, Sri Amritsar, India, from November 2018-August 2020. Total 50 cases were selected and operated by lap/open cholecystectomy were included in this study. During cholecystectomy bile was aspirated and was sent to laboratory for culture. Gallstone retrieved from the specimen was classified based on morphological appearance. Results: Gallstone disease found to be common in female 92% and in the age group of 4-50 years. Bile of gallstones patients is often infected. In this study though morphologically cholesterol stones were commonest but mixed stones were associated with highest infection rates. Most common bile infecting bacterium in all kinds of stones was found to be E. coli 60.8% followed by klebsiella 17.3% and proteus 17.3%. All the organisms cultured were sensitive to cephalosporins, quinolones, aminoglycosides and penicillin group of antibiotics.Conclusions: Bile culture was positive in 46% of the cases. Morphologically cholesterol stones were commonest 52% but mixed stones were associated with highest infection rates (80%). Most common bile infecting bacterium in all kinds of stones was found to be E. coli.

Three Dimensional Ultra-short Echo Time MRI Can Depict Cholesterol Components of Gallstones Bright.

PurposeNon-calcified cholesterol stones that are small in size are hard to be depicted on CT or magnetic resonance cholangiopancreatography. This institutional review board (IRB)-approved retrospective in vitro study aims to characterize contrast behaviors of 3 main components of the gallstones, i.e., cholesterol component (CC), bilirubin calcium component (BC) and CaCO3 (CO) on 3D radial scan with ultrashort TE (UTE) MRI, and to test the capability of depicting CC of gallstones as bright signals as compared to background saline.MethodsFourteen representative gallstones from 14 patients, including 15 CC, 6 BC and 4 CO, were enrolled. The gallstones underwent MRI including fat-saturated T1-weighted image (fs-T1WI) and UTE MRI with dual echoes. The contrast-to-noise ratio (CNR) and the chemical analysis for the 25 portions of the stones were compared.ResultsBC was bright on fs-T1WI, which did not change dramatically on UTE MRI and the signal did not remain on UTE subtraction image between dual echoes. Whereas the CC was negative or faintly positive signal on fs-T1WI, bright signal on UTE MRI and the contrast remained even higher on the UTE subtraction, which reflected their short T2 values. Median CNRs and standard errors of the segments on each imaging were as follows: on fs-T1WI, −10.2 ± 4.2 for CC, 149.7 ± 27.6 for BC and 37.9 ± 14.3 for CO; on UTE MRI first echo, 16.7 ± 3.3 for CC, 74.9 ± 21.3 for BC and 17.7 ± 8.4 for CO; on UTE subtraction image, 30.2 ±2.0 for CC, −11.2 ± 5.4 for BC and 17.8 ± 10.7 for CO. Linear correlations between CNRs and cholesterol concentrations were observed on fs-T1WI with r = −0.885, (P < 0.0001), UTE MRI first echo r = −0.524 (P = 0.0072) and UTE subtraction with r = 0.598 (P = 0.0016).ConclusionUTE MRI and UTE subtraction can depict CC bright.

Diseases of the gallbladder in children — modern view of pediatric surgeon (systematic review)

Currently, the two main causes of diseases of the gallbladder in children are biliary dyskinesia and the formation of gallbladder stones. Biliary dyskinesia is an independent disease and is caused mainly by reduced motility of the gallbladder, which leads to its insufficiently good emptying and is accompanied by chronic pain abdominal syndrome. The causes of stone formation in children differ from the sources of stone formation in adults. Metabolic disorders, mainly against the background of obesity, lead to the formation of cholesterol stones, which is the most common cause of cholelithiasis in children. Blood diseases is another factor of cholelithiasis associated with hemolysis, such as sickle cell anemia, hereditary spherocytosis, and thalassemia. Symptoms of gallbladder disease are mainly in chronic abdominal pain syndrome. Inflammation of the gallbladder is a fairly rare form of the course of gallstone disease in children. The current surgical technology for treatment of gallbladder diseases in children, as in adults, is cholecystectomy, which can be realized depending on the degree of mastery of endosurgical skills using standard four-port laparoscopic techniques or a single laparoscopic approach. This review addresses the issues of semiotics, etiology, diagnosis, and surgical treatment of gallbladder disease in pediatric patients. The scientific work answers many controversial questions regarding the diagnosis of biliary dyskinesia, the choice of diagnostic method for concomitant choledocholithiasis, and the selection of the most effective surgical approach.

Histopathologic Features of 1000 Cholecystectomy Specimens

Background: One of the most common gastrointestinal surgeries is cholecystectomy. Gallstones are the major causes of cholecystectomy and induce various histopathologic changes. Gallbladder carcinoma is rare with poor prognosis. Metaplasic changes in gallbladder epithelium are considered precancerous lesions. Objectives: This study aimed at revealing the spectrum of histopathological patterns of gallbladder diseases in cholecystectomy specimens. Methods: A total of 1004 gallbladder H &amp; E stained slides of cholecystectomy specimens over one year were studied. Histopathological evaluation was done by 6 pathologists in terms of variables. Results: In our study, the male: female ratio was 1:2.1. The age of patients varied from 17 to 96 years with a mean age of 49.1 years. The mean age of patients with gallstones was 47.52 years and was more common in women. Cholesterol, pigmented, and mixed stones were reported in 58.36%, 39.03%, and 2.6% of gallstones, respectively. The most common histological morphology was chronic calculous cholecystitis (61.18%). The incidence of metaplasia and invasive carcinoma was 19.55% and 0.2%, respectively. Conclusions: In this study, histopathological analysis of gallbladder diseases in the cholecystectomy specimens revealed that chronic calculous cholecystitis was the most common histologic finding. Gallstones were found more commonly in women and cholesterol stone was the predominant type. Pyloric metaplasia was the most frequent type of metaplasia. The rate of invasive carcinoma is compatible with those reported in the literature. Routine histopathological analysis of the cholecystectomy specimens will help to detect incidental carcinoma and precursors of malignancy.

Epidemiology of Gall Stone Diseases among Patients attending Surgical Department of a Tertiary Care Hospital in Nepal

Background and Objectives: Gallstone disease (GSD) is a chronic disease that consumes a lot of economic and medical resources. It not only affects patients’ life quality, but also is associated with the potential risks of the development of consequences of gallstone diseases. Therefore, the study is aimed to investigate the epidemiology and risk factors of gall stone diseases among patients attending tertiary care centre in Nepal.&#x0D; Material and Methods: A cross sectional study was conducted among patients attending surgical department of Janaki Medical College Teaching Hospital (JMCTH) over a period of one year from January 2019 to December 2019. Chi-square test was applied to show the association between the two groups. P-value &lt; 0.05 was considered statistically significant.&#x0D; Results: In a total of 148 patients, 69.59% had mixed gallstone, 17.57% had cholesterol stone and 12.84% had pigment gallstone. Types of gallstone was found significant for age group (p=0.006), gender (p=0.027) and presence of diabetes (p=0.003) but insignificant with presence of hypertension (p=0.992).&#x0D; Conclusion: Age of the patients, gender and presence of diabetes were found significant for the all types of gall stone. Further large scale research need to be conducted.

The effect of ursodeoxycholic acid on the relative expression of the lipid metabolism genes in mouse cholesterol gallstone models

BackgroundMany studies indicate that gallstone formation has genetic components. The abnormal expression of lipid-related genes could be the basis for particular forms of cholesterol gallstone disease. The aim of this study was to obtain insight into lipid metabolism disorder during cholesterol gallstone formation and to evaluate the effect of ursodeoxycholic acid (UDCA) on the improvement of bile lithogenicity and its potential influence on the transcription of lipid-related genes.MethodsGallstone-susceptible mouse models were induced by feeding with a lithogenic diet (LD) for 8 weeks. Bile and liver tissues were obtained from these mouse models after 0, 4 and 8 weeks. Bile lipids were measured enzymatically, and the cholesterol saturation index (CSI) was calculated to evaluate the bile lithogenicity by using Carey’s critical tables. Real-time polymerase chain reaction (RT-PCR) was used to detect the mRNA expression levels of farnesoid X receptor (FXR), liver X receptor (LXR), adenosine triphosphate-binding cassette subfamily G member 5/8 (ABCG5/8), cholesterol 7-α hydroxylase (CYP7A1), oxysterol 7-α hydroxylase (CYP7B1), sterol 27-α hydroxylase (CYP27A1), peroxisome proliferator-activated receptor alpha (PPAR-α) and adenosine triphosphate-binding cassette subfamily B member 11 (ABCB11).ResultsThe rate of gallstone formation was 100% in the 4-week group but only 30% in the UDCA-treated group. The UDCA-treated group had a significantly lower CSI compared with other groups. Of special note, the data on the effects of UDCA showed higher expression levels of ABCG8, ABCB11 and CYP27A1, as well as lower expression levels of LXR and PPAR-α, compared to the model control group.ConclusionsUDCA exhibits tremendously potent activity in restraining lipid accumulation, thus reversing the lithogenic effect and protecting hepatocytes from serious pathological damage. The abnormal expression of ABCG8, CYP7A1, CYP27A1, LXR and PPAR-α might lead to high lithogenicity of bile. These results are helpful in exploring new lipid metabolism pathways and potential targets for the treatment of cholesterol stones and for providing some basis for the study of the pathogenesis and genetic characteristics of cholelithiasis. Research on the mechanism of UDCA in improving lipid metabolism and bile lithogenicity may be helpful for clinical treatment and for reducing the incidence of gallstones.

Incidence and risk factors for postoperative common bile duct stones in patients undergoing endoscopic extraction and subsequent cholecystectomy

In patients who undergo cholecystectomy after endoscopic common bile duct (CBD) stone extraction, CBD stones found postoperatively could be problematic. This study aimed to investigate the incidence and risk factors of postoperative CBD stones after cholecystectomy. A total of 278 patients (mean age, 59.2 years; 71 men [51.1%]) who underwent endoscopic removal of CBD stones followed by cholecystectomy from January 2013 to December 2017 were included. An endoscopic nasobiliary drainage (ENBD) tube was placed immediately after endoscopic clearance of the CBD stones in all patients until cholecystectomy. An ENBD tubogram was obtained in all patients to determine the presence of postoperative CBD stones. Postoperative CBD stones were detected in 20.1% (56/278). An ENBD tubogram was obtained after an average of 2.42 days postoperatively. Based on univariate analysis, the statistically significant risk factors for postoperative CBD stone were CBD stones >2, CBD stone size >10mm, cholesterol stone, maximum diameter of CBD >15mm, treatment with endoscopic sphincterotomy alone, and use of endoscopic mechanical lithotripsy (EML). In multivariate analysis, cholesterol stone, CBD stones >2, CBD stone size >10mm, and EML were related to postoperative CBD stones after cholecystectomy. Based on the relatively high rate of postoperative CBD stones after cholecystectomy, careful follow-up should be considered in patients with high-risk factors to detect CBD stones early.

Morphological and Biochemical Analysis of Gallstones in Lahore, Pakistan.

Introductions: Gallstones are formed within the gallbladder or in biliary tract. They can be termed as cholesterol stones whose major constituent is cholesterol or pigment stones which mainly are composed of bilirubin or there can be calcium and oxalate stones too. The aim of this study was to establish the composition of stones found within the gallbladder after cholecystectomy for symptomatic gallstones. Material and Methods: This study was conducted in a tertiary care hospital (Services Hospital Lahore) from 1st August-2017 to 30th June-2018. After examining the physical characteristics of the stones (color, number, shape and surface) were analyzed by semi- quantitative colorimetric analysis. Demographic data, morphology of stones and the percentage different chemical components were noted on pre-established performa and analyzed by SPSS software version 22. Results: A total 200 people were recruited in the study. The mean age of the patients was 37.82 ± 11.67 years. 90% patients were female and 10% patients were males. 10% cases had solitary stone while 90% cases had multiple stones. 25% patients had light brown stones, 30% had dark brown stones, 35% had gray stones and 10% had black stones. 85% cases had mixed stones whereas 15% had cholesterol stones. The mean percentages by weight of calcium, cholesterol, iron, phosphorus and bilirubin were 50± 10.59%, 27.45± 11.57%, 14.3± 6.28%, 13.25± 8.36% and 5.1± 2.46% respectively. Conclusion: It is concluded that gallstone disease is common in third decade of life and mixed stones is the most frequent variety of gallstones and calcium is the most abundant substrate of the gallstone

Role of Baicalin and Liver X Receptor Alpha in the Formation of Cholesterol Gallstones in Mice.

This study was aimed at investigating the effect of baicalin on experimental cholesterol gallstones in mice. The mouse gallstone model was induced by feeding with a lithogenic diet, and cholesterol stones were found in the gallbladder. The lithogenic diet caused elevation of triglycerides, cholesterol, and low-density lipoprotein concentrations and descent of high-density lipoprotein concentration in serum. Hyperplasia and inflammatory infiltration were observed in the gallbladder wall of lithogenic diet-fed mice. We also found the increase of cholesterol content and the decrease of bile acid in bile. Real-time PCR and western blot results demonstrated that the expression levels of two enzymes (cholesterol 7α-hydroxylase (CYP7a1) and sterol 12α-hydroxylase (CYP8b1)) to catalyze the synthesis of bile acid from cholesterol were decreased and that two cholesterol transporters (ATP-binding cassette transporter G5/G8 (ABCG5/8)) were increased in the liver of lithogenic diet-fed mice. The lithogenic diet also led to enhanced activity of alanine aminotransferase and aspartate aminotransferase in serum; increased concentrations of tumor necrosis factor-α, interleukin- (IL-) 1β, IL-6, and malondialdehyde; and decreased superoxide dismutase activity in the liver, suggesting inflammatory and oxidative stress. In addition, liver X receptor alpha (LXRα) was increased in the liver. After gavage of baicalin, the lithogenic diet-induced gallstones, hyperlipidemia, gallbladder hyperplasia, inflammation, and oxidative stress in liver and cholesterol metabolism disorders were all alleviated to some degree. The expression of LXRα in the liver was inhibited by baicalin. In addition, the LXRα agonist T0901317 aggravated lithogenic diet-induced harmful symptoms in mice, including the increase of gallstone formation, hyperlipidemia, hepatic injury, inflammation, and oxidative stress. In conclusion, we demonstrated that baicalin played a protective role in a lithogenic diet-induced gallstone mouse model, which may be mediated by inhibition of LXRα activity. These findings may provide novel insights for prevention and therapy of gallstones in the clinic.

Histopathologic Spectrum of Gallbladder in Cholecystectomy Specimens

Background: Cholecystitis is a common problem in adult population. Gross and microscopic examination of gall bladder has multiple findings. Presence of stones is one of the known etiologic factors to produce histopathological changes in gallbladder. It is also one of the predisposing factors for the development of gallbladder carcinoma. This study aims to find the histopathologic spectrum of gall bladder specimens received in pathology department after undergoing surgical intervention. Objective: To analyze the morphological spectrum of cholecystitis due to stones. To find out the possible risk factors for gall stone formation. To find out the frequency / prevalence of different types of gall stones. Study Design: Retrospective Study. Settings: Department of pathology, UMDC Faisalabad and at Meezan Lab Faisalabad-Pakistan. Duration: From January 15, 2015 to May 14, 2017. Methodology: This study was conducted on cholecystectomy specimens. All clinical data was taken from patient’s histopathology request form and from patient’s clinical record gross and microscopic features of gall bladder specimens were studied in correlation with presence or absence of gall stones. Results: The total number of cholecystectomy specimens studied were 664. There were 633 cases of chronic calculous cholecystitis, the highest incidence of these being in the age group of 31-40 years. In this, males were 132 and females were 532. All patients underwent ultrasonography to confirm the diagnosis. There were 31 cases of a calculus cholecystitis. On morphological analysis, the commonest gall stones were cholesterol stones and the commonest lesion was chronic cholecystitis by histopathology. Conclusion: This study concludes the predominance of chronic calculous cholecystitis in our study population. Among these cholesterol stones are more prevalent.