Which among the following does not lead to pigment gallstones -
In TPN, there is cholesterol and mixed stones due hypomotility of Gallbladder and leading to stasis and biliary sludge. Predisposing factors for pigment gallstone formation Demographic/genetic factors: Asia, rural setting Chronic hemolysis Alcoholic cirrhosis Pernicious anemia Chronic biliary tract infection, parasite infections (Escherichia coli, Ascaris lumbricoides, Clonorchis sinensis) Increasing age Ileal disease, ileal resection or bypass Cystic fibrosis There are two kinds of pigment stones Black pigment stones composed of either pure calcium bilirubinate or polymer-like complexes with calcium and mucin glycoproteins they are more common in patients with chronic hemolytic states (eg. hereditary spherocytosis, sickle cell disease) mechanical prosthesis like hea valves. liver cirrhosis Gilbe's syndrome Cystic fibrosis ileal disease, ileal resection or bypass Brown stones are composed of calcium salts of unconjugated bilirubin with varying amounts of cholesterol and protein (eg. calcium bilirubinate, calcium palmitate and calcium sterate) are typically found in Asia. Brown stones are rare in gallbladder. They form in bile duct and are related to bile stasis and infected bile. gram-negative bacteria (paicularly E. coli) secretes b-glucoronidase which deconjugates the soluble conjugated bilirubin. The free unconjugated bilirubin precipitates and combines wtih calcium and bile to form brown pigment stones. They form whenever static foreign bodies are present in the bile duct, for example 'stents' or parasites such as Clonorchis sinensis and Ascaris lumbricoides. Ref : Bailey & Love, 25/e p1120
TPN
Clonorchis sinensis
Hemolytic anemia
Alcoholic cirrhosis
G.I.T