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2nd mbbs pathology
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cholelithiasis AND risk factors
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Merck Manual chronic cholecystitis gallstones microscopic features
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a) Diagnosis
Chronic calculous cholecystitis due to cholelithiasis.
Recurrent right-upper-quadrant pain after fatty meals occurs because gallbladder contraction transiently obstructs the cystic duct with a stone. Thickened gallbladder wall indicates chronic inflammation and fibrosis.
Microscopic features
- Chronic inflammatory infiltrate, chiefly lymphocytes and plasma cells, in the gallbladder wall.
- Subepithelial and subserosal fibrosis with thickening of the wall.
- Mucosal atrophy with epithelial flattening, sometimes intestinal or pyloric metaplasia.
- Rokitansky-Aschoff sinuses: mucosal epithelial outpouchings extending into/through the muscular wall.
Robbins & Kumar Basic Pathology describes marked subepithelial and subserosal fibrosis, lymphocytic infiltrates, and prominent Rokitansky-Aschoff sinuses in chronic cholecystitis (p. 632).
b) Types of gallstones with composition
| Type | Composition |
|---|---|
| Cholesterol stones | 50% to 100% cholesterol, with variable calcium carbonate, calcium phosphate, and bilirubin. |
| Pigment stones | Mainly calcium bilirubinate (calcium salts of unconjugated bilirubin), plus variable calcium salts, mucin glycoproteins, and cholesterol. Includes black and brown pigment stones. |
c) Risk factors for gallstone formation
For cholesterol stones
- Female sex, pregnancy, multiparity, estrogen therapy/oral contraceptive use
- Increasing age
- Obesity, metabolic syndrome, dyslipidemia
- Rapid weight loss, fasting, total parenteral nutrition
- Family history/genetic predisposition and high-risk ethnic background
- Gallbladder hypomotility or stasis, for example in pregnancy or spinal cord injury
For pigment stones
- Chronic hemolytic states, such as hereditary spherocytosis or sickle-cell disease
- Biliary tract infection or parasitic infestation
- Cirrhosis
- Ileal disease/resection, including Crohn disease
For a short 4-mark answer, remember the cholesterol-stone risks as: female, fertile, fat, forty, family history, plus rapid weight loss.
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