Cholesterol Gallstones : Pathophysiology

Comments:
Pathophysiology of Cholesterol Gallstones (continued from the previous image): Besides supersaturation, the process of gallstone formation involves nucleation. Mucins and immunoglobulins promote nucleation whereas apolipoproteins A-I and A-II inhibit nucleation.

The nidus for cholesterol nucleation and crystallization is provided by an amorphous matrix of bilirubin, bile salts, mucin glycoproteins, calcium carbonate (small amounts), phosphate, copper, and sulphur.

Solid plate-like cholesterol monohydrate crystals get deposited around the nidus both concentrically and radially. The growth of stones is a discontinuous process and occurs via cyclic deposition of calcium bilirubinate, other calcium salts, and mucin glycoproteins followed by more layers of cholesterol crystals.

The image shows cholesterol stones in an inflamed gallbladder (acute calculous cholecystitis).