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What
we call "pigment stones" are worth knowing about. The pathologist
examining the gallbladder should make a comment in her report indicating
whether she feels the gallstones could be pigmentary in nature.
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Pigment stones are formed
from bile salts and unconjugated bilirubin (the word to pay
attention to here is unconjugated).
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Unconjugated bilirubin
is normally a very small part of bile.
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We see increases when
infection
leads to microbial beta-glucuronidases hydrolyzing conjugated bilirubin
back into its unconjugated form.
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E. coli, Ascaris
lumbricodes
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Another explanation for
high levels of unconjugated bilirubin in the bile would be intravascular
RBC hemolysis.
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Pigment stones are a real problem
for people with congenital hemolytic anemias: sickle cell disease,
etc.
-
Show
me some.
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