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Chemical characterization of gallstones: an approach to explore the aetiopathogenesis of gallstone disease in Sri Lanka.

Weerakoon H, Navaratne A, Ranasinghe S, Sivakanesan R, Galketiya KB, Rosairo S - PLoS ONE (2015)

Bottom Line: All the patients had primary gallbladder stones.Only 10 (9%) had pure cholesterol gallstones.Hence it is imperative to explore this further to understand the aetiopathogenesis of GS among Sri Lankans.

View Article: PubMed Central - PubMed

Affiliation: Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka; Post Graduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka.

ABSTRACT

Introduction: Records on gallstones and associated ailments in Sri Lankan community are scarce, despite frequent detection of gallstone disease. Identification of the chemical composition of gallstones in the local setting is important in defining aetiopathogenic factors which in turn are useful in implementing therapeutic and preventive strategies. This study aimed to describe the chemical composition of gallstones and the socio-demographic factors of a cohort of Sri Lankan patients with gallstone disease.

Materials and methods: Data on clinical and socio-demographic factors, and gallstones removed at surgery were collected from patients with cholelithiasis admitted to Teaching Hospital, Peradeniya, Sri Lanka from May 2011 to December 2012. External and cross sectional morphological features of gallstones were recorded by naked eye observation. Compositional analysis was carried out by Fourier Transform Infrared Spectroscopy, X - ray Powder Diffraction, and Atomic Absorption Spectrophotometry. Scanning Electron Microscopy was used to identify the microstructure of gallstones.

Results: Data of 102 patients were analyzed. Of them majority (n = 77, 76%) were females with a female: male ratio of 3:1. Mean age of the study group was 46.1±11.6 years. All the patients had primary gallbladder stones. According to the physical and chemical analysis, majority (n = 54, 53%) were pigment gallstones followed by mixed cholesterol gallstones (n = 38, 37%). Only 10 (9%) had pure cholesterol gallstones. Calcium bilirubinate, calcium carbonate and calcium phosphate were the commonest calcium salts identified in pigment gallstones and core of mixed cholesterol gallstones.

Conclusion: Presence of a pigment nidus in gallstones is a common feature in majority of Sri Lankan patients denoting the possible role of elevated unconjugated bilirubin in bile on the pathogenesis of GS. Hence it is imperative to explore this further to understand the aetiopathogenesis of GS among Sri Lankans.

No MeSH data available.


Related in: MedlinePlus

Microstructure and calcium distribution of different types of gallstones.A, B—Pure cholesterol stone showing plate and lamella shaped cholesterol crystals. C—Mixed cholesterol stone showing predominantly distributed lamella shaped cholesterol particles with scattered calcium bilirubinate particles. D—Calcium distribution of the mixed cholesterol GS. E- Pigment stone showing irregularly arranged calcium bilirubinate clumps. F—Calcium distribution of the pigment GS of an area composed of calcium bilirubinate in the pigment GS. G—Pigment stone showing irregularly arranged calcium bilirubinate particles and protein streaks. H—Calcium distribution of the pigment stone of an area composed of calcium bilirubinate and protein. I—Pigment stone showing bulbiform calcium phosphate crystals. J—Calcium distribution of the pigment stone of an area composed of calcium phosphate crystals.
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pone.0121537.g004: Microstructure and calcium distribution of different types of gallstones.A, B—Pure cholesterol stone showing plate and lamella shaped cholesterol crystals. C—Mixed cholesterol stone showing predominantly distributed lamella shaped cholesterol particles with scattered calcium bilirubinate particles. D—Calcium distribution of the mixed cholesterol GS. E- Pigment stone showing irregularly arranged calcium bilirubinate clumps. F—Calcium distribution of the pigment GS of an area composed of calcium bilirubinate in the pigment GS. G—Pigment stone showing irregularly arranged calcium bilirubinate particles and protein streaks. H—Calcium distribution of the pigment stone of an area composed of calcium bilirubinate and protein. I—Pigment stone showing bulbiform calcium phosphate crystals. J—Calcium distribution of the pigment stone of an area composed of calcium phosphate crystals.

Mentions: SEM images and the calcium distribution obtained for three types of stones are shown in Fig 4 and the elemental composition obtained by EDS is summarized in Table 2. In pure cholesterol GS, cholesterol crystals appeared as tightly packed plate or lamella shaped structures (Fig 4A and 4B). Detection of carbon as the main element (> 99% of weight) by EDS followed by oxygen suggests the presence of cholesterol crystals. Detection of calcium in very minor percentage by weight and the absence of nitrogen and phosphorus confirms that this stone as a pure cholesterol GS. Similar to the pure cholesterol GS, plate and lamellar shaped structures suggestive of cholesterol were detected in the mixed cholesterol GS (Fig 4C). The irregular small particles seen in addition to cholesterol crystals (Fig 4C) were identified as calcium bilirubinate according to the EDS results (Fig 4D). The irregular small particles (Fig 4E) seen in the pigment stone were identified as calcium bilirubinate particles by EDS (Fig 4F). Streak like structures (Fig 4G) were confirmed as protein streaks due to the detection of nitrogen by EDS (Fig 4H). Moreover, the EDS percentages for calcium (Fig 4J) and phosphorus confirmed the bulbiform structures seen in Fig 4I are calcium phosphate crystals.


Chemical characterization of gallstones: an approach to explore the aetiopathogenesis of gallstone disease in Sri Lanka.

Weerakoon H, Navaratne A, Ranasinghe S, Sivakanesan R, Galketiya KB, Rosairo S - PLoS ONE (2015)

Microstructure and calcium distribution of different types of gallstones.A, B—Pure cholesterol stone showing plate and lamella shaped cholesterol crystals. C—Mixed cholesterol stone showing predominantly distributed lamella shaped cholesterol particles with scattered calcium bilirubinate particles. D—Calcium distribution of the mixed cholesterol GS. E- Pigment stone showing irregularly arranged calcium bilirubinate clumps. F—Calcium distribution of the pigment GS of an area composed of calcium bilirubinate in the pigment GS. G—Pigment stone showing irregularly arranged calcium bilirubinate particles and protein streaks. H—Calcium distribution of the pigment stone of an area composed of calcium bilirubinate and protein. I—Pigment stone showing bulbiform calcium phosphate crystals. J—Calcium distribution of the pigment stone of an area composed of calcium phosphate crystals.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390354&req=5

pone.0121537.g004: Microstructure and calcium distribution of different types of gallstones.A, B—Pure cholesterol stone showing plate and lamella shaped cholesterol crystals. C—Mixed cholesterol stone showing predominantly distributed lamella shaped cholesterol particles with scattered calcium bilirubinate particles. D—Calcium distribution of the mixed cholesterol GS. E- Pigment stone showing irregularly arranged calcium bilirubinate clumps. F—Calcium distribution of the pigment GS of an area composed of calcium bilirubinate in the pigment GS. G—Pigment stone showing irregularly arranged calcium bilirubinate particles and protein streaks. H—Calcium distribution of the pigment stone of an area composed of calcium bilirubinate and protein. I—Pigment stone showing bulbiform calcium phosphate crystals. J—Calcium distribution of the pigment stone of an area composed of calcium phosphate crystals.
Mentions: SEM images and the calcium distribution obtained for three types of stones are shown in Fig 4 and the elemental composition obtained by EDS is summarized in Table 2. In pure cholesterol GS, cholesterol crystals appeared as tightly packed plate or lamella shaped structures (Fig 4A and 4B). Detection of carbon as the main element (> 99% of weight) by EDS followed by oxygen suggests the presence of cholesterol crystals. Detection of calcium in very minor percentage by weight and the absence of nitrogen and phosphorus confirms that this stone as a pure cholesterol GS. Similar to the pure cholesterol GS, plate and lamellar shaped structures suggestive of cholesterol were detected in the mixed cholesterol GS (Fig 4C). The irregular small particles seen in addition to cholesterol crystals (Fig 4C) were identified as calcium bilirubinate according to the EDS results (Fig 4D). The irregular small particles (Fig 4E) seen in the pigment stone were identified as calcium bilirubinate particles by EDS (Fig 4F). Streak like structures (Fig 4G) were confirmed as protein streaks due to the detection of nitrogen by EDS (Fig 4H). Moreover, the EDS percentages for calcium (Fig 4J) and phosphorus confirmed the bulbiform structures seen in Fig 4I are calcium phosphate crystals.

Bottom Line: All the patients had primary gallbladder stones.Only 10 (9%) had pure cholesterol gallstones.Hence it is imperative to explore this further to understand the aetiopathogenesis of GS among Sri Lankans.

View Article: PubMed Central - PubMed

Affiliation: Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka; Post Graduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka.

ABSTRACT

Introduction: Records on gallstones and associated ailments in Sri Lankan community are scarce, despite frequent detection of gallstone disease. Identification of the chemical composition of gallstones in the local setting is important in defining aetiopathogenic factors which in turn are useful in implementing therapeutic and preventive strategies. This study aimed to describe the chemical composition of gallstones and the socio-demographic factors of a cohort of Sri Lankan patients with gallstone disease.

Materials and methods: Data on clinical and socio-demographic factors, and gallstones removed at surgery were collected from patients with cholelithiasis admitted to Teaching Hospital, Peradeniya, Sri Lanka from May 2011 to December 2012. External and cross sectional morphological features of gallstones were recorded by naked eye observation. Compositional analysis was carried out by Fourier Transform Infrared Spectroscopy, X - ray Powder Diffraction, and Atomic Absorption Spectrophotometry. Scanning Electron Microscopy was used to identify the microstructure of gallstones.

Results: Data of 102 patients were analyzed. Of them majority (n = 77, 76%) were females with a female: male ratio of 3:1. Mean age of the study group was 46.1±11.6 years. All the patients had primary gallbladder stones. According to the physical and chemical analysis, majority (n = 54, 53%) were pigment gallstones followed by mixed cholesterol gallstones (n = 38, 37%). Only 10 (9%) had pure cholesterol gallstones. Calcium bilirubinate, calcium carbonate and calcium phosphate were the commonest calcium salts identified in pigment gallstones and core of mixed cholesterol gallstones.

Conclusion: Presence of a pigment nidus in gallstones is a common feature in majority of Sri Lankan patients denoting the possible role of elevated unconjugated bilirubin in bile on the pathogenesis of GS. Hence it is imperative to explore this further to understand the aetiopathogenesis of GS among Sri Lankans.

No MeSH data available.


Related in: MedlinePlus