Gallstones are common, with some 10–15% of adults in Western countries having stones that can be demonstrated by ultrasonography, although only about one-third of these are symptomatic.

Most gallstones are composed of cholesterol and bile pigments in varying proportions. They are usually calcified to some extent. It is not known why only a minority cause symptoms.

The pathology is uncertain, but several factors are implicated in producing bile supersaturated with cholesterol:

  • reduced low-density lipoprotein (LDL) uptake by the liver;
  • up-regulation of HMG-CoA reductase, thus increasing cholesterol synthesis;
  • down-regulation of bile acid synthesis, causing reduced cholesterol solubilization in the gut;
  • distal ileal disease, causing reduced reabsorption and recycling of bile acids (another risk factor because these surfactants are needed to solubilize bilirubin and calcium);
  • gallbladder stasis causing reduced emptying.

Related Topics:

DyspepsiaPeptic UlcerNausea and Vomiting

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