Types of gallstones-cholelithiasis

(J Hepatol 2016;65:146)

• Cholesterol (90%): 2 subtypes

mixed: contain >50% cholesterol; typically smaller, multiple stones

pure: 100% cholesterol; larger, yellow, white appearance

• Pigment (10%)

Black: unconjugated bili & calcium; seen w/ chronic hemolysis, cirrhosis, CF, Gilbert synd

Brown: stasis & infxn in bile ducts → bacteria deconjugate bilirubin → precipitates w/ Ca; found pred in bile ducts; seen w/ biliary strictures, parasites, post-cholecystectomy