GALLSTONES (synonym: bilious concrements, holelita) — the dense educations forming in a gall bladder and bilious channels.
. to. were known in an extreme antiquity: K. Galen and A. Vezaly found them at a research of corpses. In 1554 Mr. J. Fernel described. to. and wedge, symptoms of cholelithiasis. G. Galeati in 1746 conducted the early chemical studies Zh. to., and in 1796. A. Waeter gave the figure Zh. to. According to pathoanatomical researches, apprx. 10% of the population of the globe is carriers Zh. to. The quantity of stones in a gall bladder can fluctuate from one to several thousand (S. P. Fedorov). The sizes of gallstones — from a grain of sand to egg, weight to 30 g and more (tsvetn. fig. 4-6). Single stones, as a rule, large, multiple — small. to. usually repeat a form of that body, in Krom they are localized: in a gall bladder they roundish, in intra hepatic canals — branchy, in the general bilious channel — ellipsoidal. Color Zh. to. various: from white or: yellow to dark-brown or black. Depending on components a consistence. to. firm, semisolid or soft.
Origins. to. it is quite difficult d cannot be considered as finally found out. In the middle of 19 century Gemsbakh's theory was created (Meckel v. Hemsbach) about «kamneobrazuyushchy Qatar», according to a cut any died-off organic matter (an epithelium, slime, etc.) can be a basis for adjournment of salts and the subsequent formation of stones. Further about a lithogenesis began to give preference in doctrines to an infectious factor.
Against the statement about the predominating role of an infection in education. to. L. Ashoff with sotr acted., who considered that emergence. to. it is connected with stagnation of bile in a bubble and disbolism. The important place in education. to. have disturbances of exchange of cholesterol (a hypercholesterolemia and a giperkholesterinkholiya) and proteins. The proteic matters of bile adsorbing bilious to - you, cholesterol, bilirubin, phospholipids and other components, form the macromolecular connections containing lecithin. Reduction of letsitinokholesterinovy coefficient (see. Cholesteric exchange ) is an important stage of education. to. Giperkholesterinkholiya is connected with decrease in level bilious to - t (protective colloids), a cut is observed at insufficient products by their hepatic cells and at stagnation of bile in a bubble. The Holatokholesterinovy coefficient (the relation bilious to - t to cholesterol) is considerably reduced at a cholelithiasis.
Some authors (N. K. Permyakov et al., B. S. Rozanov and V. A. Penin) consider a prestage of a lithogenesis a cholesterosis of a gall bladder (see. Gall bladder ). It is also necessary to point to intraparietal deposits of crystals of cholesterol in a gall bladder (so-called intramural cholesteric granulomas) which can become the reason of a lithogenesis. In some cases at education. to. the inflammatory phenomena in a mucous membrane are of great importance. The known role in the course of a lithogenesis is played by disturbance of sokratitelny functions (dyskinesia) and the stagnation of bile connected with it — cholestasia (see).
On structure. to. share on cholesteric, pigmental and cholesteric, difficult holesterino - pigmental and limy, pigmental and limy.
Cholesteric stones consist generally of cholesterol with dash of protein, lime and pigments. These stones are more often than rounded shape, belesovatozheltovaty color, smooth, easy, float in water, easily burn and burn down without the rest. On a cut in the center of a stone the pigmental kernel sometimes is located, from to-rogo crystals of cholesterol radially disperse. The pure cholesteric stone can turn in pigmental and cholesteric and holesterino - pigmental and limy, however the central part it always consists of pure cholesterol.
Difficult holesterino - pigmental известковыe stones — the most frequent look. to. In the majority they multiple also have the various form. Their size fluctuates from prosyany grain to egg, color from belesovatoserovaty to black. On a cut these stones have a concentric structure. Their kernel consists of pigments and cholesterol. Sometimes a surface of concrements rough with the whitish centers. Most often cholesterol - pigmentno - limy stones develop against the background of inflammatory processes in walls of a gall bladder and channels though, according to A. I. Abrikosov, I. V. Davydovsky, S. P. Fedorov, the inflammatory component in this case is not obligatory.
Pigmental stones are most often formed owing to stagnation of bile in a liver, extrahepatic bilious ways; they are observed and at hemolysis. As a rule, they multiple, small, with a diameter up to 1 — 1,5 cm, a soft consistence, on a section homogens, burovatocherny color. Rudiments of these stones are formed in the intra hepatic bilious courses in the form of a protein basis, bilious pigments and dash of limy salts (microlites). In some cases microlites are a basis of pigmental and limy stones of bilious channels and a bubble.
Limy stones — the dense whitish hilly educations arising owing to an inflammation when deskvamirovanny fragments of an epithelium become impregnated with limy salts. These concrements meet very seldom.
Value in pathology
Approximately in 20% of observations existence. to. the wedge, symptoms, however created is not followed. to. promote emergence various patol, processes. Quite often from pressure of a stone the wall of a gall bladder becomes thinner and stuck out in a look diverticulum (see). Perhaps also formation of ulcers and decubituses on a mucous membrane with the subsequent perforation of a wall, development of bilious peritonitis (see), subhepatic or subphrenic abscess (see) or education bilious fistulas (see), opening in a duodenum, a stomach or a small bowel.
Migration. to. can cause obturation of a vesical channel with development of an edema of a gall bladder. Obstruction by a stone of the general bilious channel leads to developing of mechanical (obturatsionny) jaundice. Large. to., dropped out through bilious fistulas in a gleam of a small bowel, can cause impassability of intestines (see). Inflammation of a gall bladder, extrahepatic bilious channels, cirrhoses of a liver (see), inflammatory changes in a pancreas in the majority develop in the presence of stones.
Existence. to. the wedge, is in most cases shown by the symptoms characterizing special cholelithiasis (see).
Bibliography Nogaller A. M. Diseases of a gall bladder and bilious ways, M., 1969, bibliogr.; Nogaller A. M. and V. B Bulls. Modern ideas of the mechanism of formation of gallstones, Klin, medical, t. 49, No. 8, page 10, 1971, bibliogr.; Resident of Perm ovn. To. SP of an odolsky. E. Holesteroz of a gall bladder, M., 1969, bibliogr.; Rozanovb. Page ipenin V. A. Holesteroz of a gall bladder, M., 1973, bibliogr.; Fedorov S. P. Gallstones and surgery of bilious ways, L. — M, 1934, bibliogr.; The bile acids, chemistry, physiology and metabolism, ed. by P. P. Nair a. D. Kri-tshevsky, v. 1—2, N. Y., 1973; The biliary system, ed. by W. Taylor, p. 601, Oxford, 1965, bibliogr.; Sherlock S h. Diseases of the liver and biliary system, Oxford, 1975.