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• W1974743229 endingPage "97" @default.
• W1974743229 startingPage "75" @default.
• W1974743229 abstract "Gallstones form as the culmination of a complex series of events that results in precipitation of insoluble substances in the gallbladder. Bile contains bile salts, physiologic detergents that can solubilize lipids. Bile salts allow the liver to excrete relatively insoluble molecules in bile and aid in the absorption of dietary lipids in the intestine. Gallstones occur when insoluble lipids and inorganic salts secreted by the liver cannot be solubilized as they normally are in bile by the detergent properties of bile salts. For this to occur, metabolic events must take place to produce bile that contains excess amounts of either cholesterol or bilirubin, both of which are relatively insoluble in aqueous solution. Additionally, physical factors must allow rapid nucleation within the residence time of bile in the biliary tree. Gallstones are divided into three major types: (1) cholesterol, (2) black pigment, and (3) brown pigment, depending on their composition and hence on their pathogenesis. Cholesterol gallstones, which constitute greater than 80% of stones in the Western world, are composed predominantly of crystals of the sterol cholesterol.122 Stones can be almost pure cholesterol and contain cholesterol monohydrate crystals agglomerated by a mucin glycoprotein matrix. Minor components of cholesterol stones include unconjugated bilirubin and small amounts of calcium phosphate. Black pigment gallstones contain calcium salts of unconjugated bilirubin, in a polymerized matrix.85 The additional presence of calcium phosphate in the mucin matrix results in opacity of black pigment stones on plain radiographs. The hallmark of brown pigment gallstones is the presence of bacterial degradation products of biliary lipids, calcium salts of fatty acids and unconjugated bilirubin,30 in addition to precipitated cholesterol. Cholesterol and black pigment stone formation is characterized by abnormalities in cholesterol and bilirubin metabolism. In contrast, brown pigment stone formation occurs only as a result of bacterial infection of the biliary tree, typically in the presence of bile stasis. This article discusses metabolic factors that underlie secretion of supersaturated bile and physical factors that allow solubilization and precipitation of the biliary lipids and calcium salts that constitute gallstones." @default.
• W1974743229 created "2016-06-24" @default.
• W1974743229 creator A5062299068 @default.
• W1974743229 date "1999-03-01" @default.
• W1974743229 modified "2023-10-03" @default.
• W1974743229 title "PHYSICAL AND METABOLIC FACTORS IN GALLSTONE PATHOGENESIS" @default.
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