DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20171228

Gall bladder stones and the associated histopathology– a tertiary care centre study

Vijayakumaran Pillai, Renjith Sreekantan, Meer M. Chisthi

Abstract


Background: Gall stones form one of the main reasons for recurrent upper abdomen pain. Cholecystectomy has turned out to be one of the commonest laparoscopic procedures done all over the world. The objectives of the study were to analyse the histopathological changes in gallstone disease and to study the clinical and biochemical factors that are seen in gall stone disease.

Methods: This was a hospital based cross sectional study conducted at a tertiary care centre from January 2013 to December 2014. 108 patients admitted with diagnosis of cholelithiasis and posted for cholecystectomy were studied. Their clinical and biochemical data and post-operative stone analysis results and histopathological reports were collected and analyzed.

Results: 63% of the patients were females with a female to male ratio of 1.7:1. Of the group, 64.8% had a BMI between 25 and 29.9. 65.7% patients got operated within one year of the onset of symptoms. Serum cholesterol levels were found elevated in majority of patients. 61% patients had multiple gall stones. 62% had stones composed of cholesterol, bilirubin, calcium carbonate and calcium oxalate. 102 out of the 108 specimens showed histological features of chronic cholecystitis only. One case showed a premalignant change in the form of pyloric metaplasia.

Conclusions: Cholelithiasis is seen mostly in females, most of them having elevated cholesterol levels. The commonest histopathological change associated with cholelithiasis is chronic cholecystitis. Premalignant lesions are seen only in a small minority only. Hence early elective cholecystectomy can prevent malignant transformation in asymptomatic gall stones.


Keywords


Biliary pain, Cholecystitis, Cholelithiasis, Gall bladder, Gall stone

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References


Bartoli E, Capron JP. Epidemiology and natural history of cholelithiasis. Rev Prat. 2000;50:2112-6.

Kalloo AN, Kanstevoy SV. Gallstones and biliary disease. Prim Care. 2001;28:591-606.

Kratzer W, Mason RA, Kachele V. Prevalence of gallstones in sonographic surveys worldwide. J Clin Ultrasound. 1999;27:1-7.

Kim MH, Lim BC, Myung SJ, Lee SK, Ohor HC, Kim YT, et al. Epidemiological study of Korean gallstone disease: a nationwide cooperative study. Dig Dis Sci. 1999;44:1674-83.

Stewart L, Ponce R, Oesterk AL, Griffiss JM, Way LW. Pigment gallstones pathogenesis: slime production by biliary bacteria is more important than beta-glucuronidase production. J Gastrointest Surg. 2000;4:547-53.

Al-Jiffry BO, Shaffer EA, Saccone GT, Downey P, Kow L, Toouli J. Changes in gall bladder motility and gall stone formation following laparoscopic banding for morbid obesity. Can J Gastroenterol. 2003;17:169-74.

Lapidus A, Bangstad M, Astrom M, Muhrheck O. The prevalence of gallstones disease in a defined cohort of patient with Crohn’s disease. Am J Gastroenterol. 1999;94:1130-2.

Hoogerbrugge-vd LN, de Rooy FW, Jansen H, van Blankenstein M. Effect of pravastatin on biliary lipid composition and bile acid synthesis on familial hypercholesterolemia. Gut. 1990;31:348-50.

Duvaldestin P, Manu JL, Metreau JM, Arondel J, Preaux AM, Berthelot P. Possible role of defect in hepatic bilirubin glucorunidation in the initiation of cholesterol gallstones. Gut. 1980;21:650-5.

Khanna R, Chansuria R, Kumar M, Shukla HS. Histological changes in gallbladder due to stone disease. Indian J Surg. 2006;68:201-4.

Giri S. Histopathological changes in gallbladder mucosa associated with cholelithiasis. IJCRR. 2013;5(4):126-9.

Tyagi SP, Tyagi N, Maheshwari V, Ashraf SM, Sahoo P. Morphological changes in diseased gall bladder: a study of 415 cholecystectomies at Aligarh. J Indian Med Assoc. 1992;90(7):178-81.

Goyal S, Singla S, Duhan A. Correlation between gallstones characteristics and gallbladder mucosal changes: A retrospective study of 313 patients. Clin Cancer Invest J. 2014;3:157-61.

Mathur SK, Duhan A, Singh S, Aggarwal M, Aggarwal G, Sen R, et al. Correlation of gallstone characteristics with mucosal changes in gall bladder. Trop Gastroenterol. 2012;33(1):39-44.

Abassi A, Qasmi SA, Ghafoor A, Kiani F, Abassi H. Frequency of carcinoma gallbladder in cases of cholelithiasis undergoing cholecystectomy at tertiary care hospital. RMJ. 2012;37(4):406-8.