The Discrepancy between Gross Features and Chemical Compositions in Gallbladder Stone: A Descriptive Single Center Study in the United Arab Emirates

Background and Study Aim: Gallbladder stone (GBS) is a common gastrointestinal disease that is the primary indication for cholecystectomy. The present study was conducted to describe the chemical composition of gallstones in a tertiary referral hospital in the United Arab Emirates. Materials and Methods: Patients diagnosed with GBS and who underwent cholecystectomy due to symptomatic GBS and cholecystitis in Sheikh Khalifa Specialty Hospital were enrolled in this study. After cholecystectomy, all stone specimens were classified according to their gross findings into 4 groups, namely black pigmented stones (BLPS), brown pigmented stones (BRPS), mixed cholesterol stones, and cholesterol stones (CLS). Quantitative analysis using Fourier transform infrared spectroscopy was then performed to define the stones’ chemical constituents. They were reclassified into two groups as CLS (cholesterol ≥ 60%) and pigmented stones (PGS, cholesterol ≤ 59%) based on gallstone composition analysis. Results: A total of 237 stones were divided into four groups based on their gross findings; cholesterol stones (32.0%), mixed cholesterol (29.2%), black pigmented (26.4%), and brown pigmented (12.3%). After chemical composition analysis, they were resorted into the two following groups according to their cholesterol proportions: pigmented (28.3%) and cholesterol (71.7%). There were significant statistical mean age differences between the pigmented and cholesterol stone groups (58.5±19.8 vs. 34.4±11.0, p < 0.01). Conclusion: This descriptive study showed the hospital-based clinical incidence of GBS and suggested that there might be a discrepancy in stone classification based on gross findings and chemical compositions. Moreover, pigmented stones are more likely to be present in older patients than cholesterol stones.

A Study on Bacterial Etiology of Cholecystitis due to Gallstones and their Antimicrobial Susceptibility Pattern in A Tertiary Care Hospital

Cholelithiasis is a very common condition affecting the Gallbladder. Gallstones are present in 10 -15 % of the adult population. Females are three times more likely to develop Gallstones than male. Gall stones are classified into cholesterol and pigment stone. About 80% of them are cholesterol stone and 15-20% pigment stone. Obstruction and infections are the common complications of Cholelithiasis. Approximately 1-2% of the patients become symptomatic and warrants cholecystectomy (1). With this background we conducted a cross sectional study in the Institute of Microbiology, MMC & RGGGH, for 72 consecutive patients who underwent cholecystectomy. The most common age group affected 41-60 yrs. The most common symptoms are abdominal pain, dyspepsia and Jaundice. In this study Gallstones are collected after surgery, processed and Antibiogram pattern also studied as per standard guidelines. Out of 72 samples studied 35 (48.6%) are culture positive. Escherichia coli is the predominant organism isolated followed by Klebsiella pneumonia(52). Most of the isolates were sensitive to commonly used antibiotics for Gram Negative bacilli.

A computer study of the risk of cholesterol gallstone associated with obesity and normal weight

Obese people differ from the people of normal weight in gall bladder motility and have a higher risk of cholesterol stone formation. In this study, using a mathematical model of cholesterol homeostasis, which also considers the enterohepatic circulation of bile as well as cholesterol, we investigated the risk of cholesterol stone formation in obese and normal-weight groups who had normal blood cholesterol levels. We associated the risk of stone formation with the amount of cholesterol released into bile and the amount of de novo-synthesized cholic acid. For both groups, we determined the conditions of low and high risk. In addition, we analyzed the potential effects of changes in gall bladder motility with increased weight. The results showed that the obese group exhibited increased kinetics of enterohepatic circulation, leading to a significant increase in blood cholesterol levels, which can be reduced by increasing the amount of cholesterol in bile. Based on this finding, we suggest that for obese people, it is beneficial to reduce the amount and change the composition of circulating bile through the inhibition of cholic acid synthesis along with cholesterol synthesis. Furthermore, obese people should maintain a triglyceride-lowering diet and consume small meals containing fat, preferably in combination with agents that can reduce bile output from the gall bladder.

Histopathologic Features of 1000 Cholecystectomy Specimens

Background: One of the most common gastrointestinal surgeries is cholecystectomy. Gallstones are the major causes of cholecystectomy and induce various histopathologic changes. Gallbladder carcinoma is rare with poor prognosis. Metaplasic changes in gallbladder epithelium are considered precancerous lesions. Objectives: This study aimed at revealing the spectrum of histopathological patterns of gallbladder diseases in cholecystectomy specimens. Methods: A total of 1004 gallbladder H & E stained slides of cholecystectomy specimens over one year were studied. Histopathological evaluation was done by 6 pathologists in terms of variables. Results: In our study, the male: female ratio was 1:2.1. The age of patients varied from 17 to 96 years with a mean age of 49.1 years. The mean age of patients with gallstones was 47.52 years and was more common in women. Cholesterol, pigmented, and mixed stones were reported in 58.36%, 39.03%, and 2.6% of gallstones, respectively. The most common histological morphology was chronic calculous cholecystitis (61.18%). The incidence of metaplasia and invasive carcinoma was 19.55% and 0.2%, respectively. Conclusions: In this study, histopathological analysis of gallbladder diseases in the cholecystectomy specimens revealed that chronic calculous cholecystitis was the most common histologic finding. Gallstones were found more commonly in women and cholesterol stone was the predominant type. Pyloric metaplasia was the most frequent type of metaplasia. The rate of invasive carcinoma is compatible with those reported in the literature. Routine histopathological analysis of the cholecystectomy specimens will help to detect incidental carcinoma and precursors of malignancy.

Epidemiology of Gall Stone Diseases among Patients attending Surgical Department of a Tertiary Care Hospital in Nepal

Background and Objectives: Gallstone disease (GSD) is a chronic disease that consumes a lot of economic and medical resources. It not only affects patients’ life quality, but also is associated with the potential risks of the development of consequences of gallstone diseases. Therefore, the study is aimed to investigate the epidemiology and risk factors of gall stone diseases among patients attending tertiary care centre in Nepal. Material and Methods: A cross sectional study was conducted among patients attending surgical department of Janaki Medical College Teaching Hospital (JMCTH) over a period of one year from January 2019 to December 2019. Chi-square test was applied to show the association between the two groups. P-value < 0.05 was considered statistically significant. Results: In a total of 148 patients, 69.59% had mixed gallstone, 17.57% had cholesterol stone and 12.84% had pigment gallstone. Types of gallstone was found significant for age group (p=0.006), gender (p=0.027) and presence of diabetes (p=0.003) but insignificant with presence of hypertension (p=0.992). Conclusion: Age of the patients, gender and presence of diabetes were found significant for the all types of gall stone. Further large scale research need to be conducted.

Study of histopathological spectrum of gallbladder in cholecystectomy specimens

Background: Cholecystitis is one of the most common indications for abdominal surgery. Routine examination of gallbladder grossly and microscopically shows lot of interesting findings. This study aims to quantify the various outcomes of routine gallbladder examination following cholecystectomy procedure.Methods: All clinical details and data from case sheet and patient history are collected and analysed for all the patients who underwent cholecystectomy surgery in the Department of General Surgery, Govt. Omandurar Medical College, Chennai, from August 2017 to August 2018. The Study period of this study was from August 2017 to August 2018. Three sections each from neck, body and fundus taken. Tissues were processed in automated tissue processor and paraffin blocks made. Statistical analysis of the data was done.Results: Total number of specimens received were 36. And among the cases the number of females were 33 and the number of males were 3. The number of cases of calculous cholecystitis were 31 and the number of cases with pigment stones were 26, number of cases with cholesterol stone were 2 and the number of cases with mixed stones were 3. The number of cases of acalculous cholecystitis were 5. The number of cases of cholecystectomy by laproscopy were 30 whereas the number of cases of cholecystectomy by open procedure were 6. Chronic cholecystitis was seen in 34 cases and chronic cholecystitis with stones was seen in 29 cases and chronic cholecystitis without stones was seen in 5 cases and Acute on chronic cholecystitis with pigment stone was seen in 1 case and xanthogranulomatous cholecystitis with pigment stone was seen in 1 case.Conclusions: The risk factors for developing chronic cholecystitis was seen in female gender. The predominant histomorphological pattern seen in this study group is chronic calculous cholecystitis. And the predominant type of stone found in this study is pigment stone compared to mixed and cholesterol stone.

Gallstones: new insights into an old story

Gallstones, particularly cholesterol gallstones, are common in Western populations and may cause symptoms such as biliary colic or complications such as acute cholecystitis or gallstone pancreatitis. Recent studies have allowed for a better understanding of the risk of symptoms or complications in patients with gallstones. In addition, newer data suggest an association of gallstones with overall mortality, cardiovascular disease, gastrointestinal cancers, and non-alcoholic fatty liver disease. Knowledge of appropriate indications and timing of cholecystectomy, particularly for mild biliary pancreatitis, has gradually accumulated. Lastly, there are exciting possibilities for novel agents to treat or prevent cholesterol stone disease. This review covers new advances in our understanding of the natural history, clinical associations, and management of gallstone disease.

HUBUNGAN ANTARA JENIS BATU DAN PERUBAHAN MUKOSA KANDUNG EMPEDU PADA PASIEN BATU KANDUNG EMPEDU

This study aimed to analyze the relationship between gallstone and histopathological changes of gallbladder mucosa among patients with gallstones. Samples consisted of 38 patients with gallstones who were performed elective cholecystectomy either by laparoscopy or by laparotomy on them. Gallstones were analyzed macroscopically to determine the types of stones. Specimens of resected gallbladders were examined histopathologically to obtain the changes of gallbladder mucosa. The results showed that macroscopical analysis resulted in three types of gallstones: cholesterol stone (76.3%), pigmented stone (21.1%), and mixed stone 2.6%). Histopathologically, all resected speciments showed changes of gallbladder mucosa in the forms of chronic inflammation or associated with hyperplasia. There was no incidental cases of gallbladder cancer. An analysis of the relationship between the types of stones and the histopathological changes of gallbladder mucosa with the chi-square test showed an X2 value of 0.483 and a P value of 0.392. Conclusion: In this study, there was no relationship between the types of gallstones and the histopathological changes of gallbladder mucosa among patients with gallstone.Keywords: gallstone, cholecystectomy, gallbladder mucosaAbstrak: Penelitian ini bertujuan untuk menganalisis hubungan batu kandung empedu dengan perubahan mukosa kandung empedu pada pasien dengan batu kandung empedu. Sampel terdiri dari 38 pasien batu kandung empedu yang menjalani operasi elektif kolesistektomi, baik secara laparoskopik maupun secara terbuka. Batu kandung empedu dianalisis secara makroskopik untuk menentukan jenis batu. Spesimen reseksi kandung empedu diperiksa secara histopatologik untuk melihat ada tidaknya perubahan mukosa kandung empedu. Dari hasil analisis batu secara makroskopik didapatkan 3 jenis batu kandung empedu, yaitu batu kolesterol (76,3%), batu pigmen (21,1%), dan batu campuran (2,6%). Semua spesimen reseksi kandung empedu diperiksa secara histopatologik dan menunjukkan perubahan mukosa kandung empedu berupa radang kronis dan hiperplasia. Tidak terdapat penemuan secara insidental terhadap kanker kandung empedu. Analisis hubungan antara jenis batu kandung empedu dan perubahan mukosa kandung empedu dengan uji chi-square mendapatkan X2 = 0,483 dengan P = 0,392. Simpulan: Dalam penelitian ini tidak didapatkan hubungan antara jenis batu dan perubahan mukosa kandung empedu pada pasien dengan batu kandung empedu.Kata kunci: batu kandung empedu, kolesistektomi, mukosa kandung empedu

Analysis of Kidney and Gall Stones of Patients from North-East Bangladesh by FTIR

Kidney and gallstones represent a prevalent and costly health problem. This study aimed to define patterns of stones and identify chemical compositions in the sample of symptomatic kidney and gallstones from North-East part of Bangladesh (Sylhet City, Sylhet) using infrared spectroscopy. Kidney and gallstones were recovered from patients of Osmani Medical College and Hospital, Sylhet, Bangladesh. A total of 5 kidney and 3 gall stone samples were collected randomly and analyzed for composition by Fourier Transform Infrared Spectroscopy (FTIR). Among the five kidney stone samples, KDS 01 was mixture of calcium oxalate monohydrate and calcium phosphate, KDS 02 and 03 were calcium oxalate and uric acid stones, KDS 04 was uric acid stone and KDS 05 was calcium oxalate dehydrate and calcium phosphate. Among the three gall stone samples, GBS 01 was cholesterol stone, GBS 02 was mixed stone and GBS 03 was pigment stone. © 2014 JSR Publications. ISSN: 2070-0237 (Print); 2070-0245 (Online). All rights reserved. doi: http://dx.doi.org/10.3329/jsr.v6i3.16721 J. Sci. Res. 6 (3), 553-561 (2014)