Extra Cholelithiasis

Extra cholelithiasis Fundamental reminders Bile is synthesized in the liver lobules by hepatocytes (approximately 500 ml/day). It is essentially made up of water (82%), bile acids (12%), lecithins and other phospholipids (4%), non-esterified cholesterol, conjugated bilirubin, electrolytes, mucus and proteins. It leaves the liver through the right and left hepatic ducts which merge to form the common hepatic duct. This receives the cystic duct, which drains the gallbladder, and becomes bile duct (or common bile duct), to open into the hepato-pancreatic ampulla (Ampulla of Vater) with the pancreatic duct. A sphincter (sphincter of Oddi, or sphincter of the hepatopancreatic ampulla) regulates the release of bile and pancreatic juice from this ampulla into the descending part of the duodenum. Cholecystokinin (CCK), produced by the duodenal mucosa, reduces the resistance of this sphincter, causing contractions of the gallbladder and stimulates the production of bile by the liver. Pathological anatomy Constitution of calculations -Cholesterol stones and mixed stones represent 80% of cases, pigment stones represent the remaining 20%. Their composition is summarized in the table below:

Cholesterol Calculations (made up of more than 50% of cholesterol) Pigment stones (contain less than 20% cholesterol) cholesterol (+++), calcium salts, bile pigments, proteins, fatty acids calcium bilirubinate (++ + ), cholesterol