Two major type gallstones have been described which have different characteristics and etiologies, cholesterol and pigment gallstone. Fromation of cholestrol gallstones depend upon 2 factors, cholesterol superstaturation and nucleation, and it has been proposed that cholesterol gallstones originates from microcrystals of cholesterol.
Pigment stones, esp. calcium bilirubinate stones occur most commonly in association with chronic infectious cholangitis that is almost unique to Orient. The pigment is present entirely as unconjugated bilirubte to the formation of pigment stones by pro ducign fl-glucuronidase and thus deconjugating bilirubin diglucuronide to unconjugated bilirubin which in turn combines with calcium, leading to stone formation.
Bile samples were obtained by Entero-Test, centrifuged and a single drop was immediately examined microscopically, and bacteria isolated from bile were cultured and the fl-glucurondase activity were determined.
The results were as follows:
1. Total 51 patients were studies; 18 GB stones, 18 CBD stones, and 15 controls.
2. Of the 18 GB stones, 15 (83%) had CMC (Cholesterol Monohydrate Crystal) and
4(22%) of the 18 CBD stones had CMC. (p<0.01 3(17%) of 18 GB stones and
11(61%) of 18 CBD stones had CBG (Calcium Bilirubinate Granule). (p<0.01)
3. No significant difference was found in bacterial incidence between GB and CBD
stones. Most frequently isolated bacteria was Escherichia coli and it was more com-
mon in CBD stones than in GB stones. (p<0.05)
4. (3-glucuronidase activity was found only in CBD stones and was 100% in Escherichia coli.
These result suggest that crystalization and (3-glucuronidase activity secondary to bacterial infection have an important role in the formation of cholesterol and pigment
´ gallstone, and microscopic bile examination may be helpful in predicting the presence of gallstones.
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