What is Gallstone Analysis? 

Gallstones are hard mineralised deposits of bile formed in the gallbladder - a tiny, pouch-like organ located below the liver. Bile is a liquid produced by the liver for digestion of fats. It is mostly water but also contains some fats, bile salts and pigments. While it is not being used, bile is stored inside the gallbladder where it becomes more concentrated, making it better at fat digestion. Whenever required, the gallbladder releases bile into the digestive system.

Gallstones form when there is an imbalance in the chemical composition of bile in the gallbladder, i.e. when there is excess cholesterol (a fatty substance), excess bilirubin (a pigment) or less bile salts in the bile. The exact reason for these imbalances is not clear. 

Gallstones may also form if the gallbladder does not empty the bile often enough or completely.

Depending on their composition, there are two types of gallstones: cholesterol and pigment stones. The size of gallstones can vary from a tiny grain of salt to the size of a golf ball.

In medical parlance, gallstone formation is known as cholelithiasis. Cholelithiasis is a significant health problem all over the globe, affecting 10-20% of the world population. If left untreated, gallstones can cause complications such as infection and inflammation of the gallbladder (cholecystitis), jaundice and pancreatitis (inflammation of the pancreas).

The following factors increase the risk of gallstones:

Gallstone analysis is performed to detect the chemical components of gallstones using various techniques.

(Read more: Kidney stone analysis)

  1. Why is Gallstone Analysis performed?
  2. How do you prepare for Gallstone Analysis?
  3. How is Gallstone Analysis performed?
  4. What do Gallstone Analysis results mean?

The standard treatment to remove gallstones is cholecystectomy (surgery to remove the gallbladder). However, in some cases, stones may occur in the gallbladder duct after gallbladder removal. In such conditions, doctors order a gallstone analysis to identify the chemical components of a gallstone so as to find the reason for the recurrence and find the right treatment.

Gallstone analysis is also helpful in determining the possible cause of cholelithiasis.

Gallstones usually produce no symptoms as such, but blocking of the bile ducts by a gallstone can lead to sudden, intense pain in the upper right abdomen which typically lasts for one to five hours. Some people with gallstones develop infection or inflammation of the gallbladder, liver or pancreas, which can lead to:

  • Jaundice (yellowish tint to the skin and eyes)
  • High fever
  • Persistent pain
  • Tea-coloured urine
  • Pale stools
  • Nausea
  • Vomiting

No preparation is necessary before this test.

The gallstone/s are removed from the patient’s body through surgery and will be sent to the laboratory for testing. The following methods are used for the analysis:

  • Colorimetry method checks for the concentration of cholesterol, bilirubin and calcium in the stone.
  • FTIR (Fourier transform infrared spectroscopy) is a physical analysis of the composition of gallstones. The IR spectrum pattern helps in classifying gallstones. FTIR also helps in determining if the stone comprises a single component or multiple components, for example, a cholesterol stone or mixed stone. It is a rapid and quick method to determine the pathway involved in the stone formation.
  • Gas-liquid chromatography (GLC) identifies the fatty acid content in cholesterol and pigment stones.

The main types of gallstones detected by gallstone analysis are:

  • Cholesterol stones: These are the commonest type of gallstones. They are oval, yellow-green in colour and have a cholesterol content of > 80%.
  • Pigment stones: These are small, dark stones which mainly contain bilirubin and calcium salts, with a cholesterol content of < 20%. Pigment stones are subdivided into brown and black stones. Black stones occur in the gallbladder and are associated with conditions such as haemolytic anaemia and cirrhosis. Brown stones form in the bile duct and are associated with parasitic infections or bacterial infections in the bile duct.
  • Mixed stones: These stones contain a mixture of cholesterol (20-80%), bilirubin and calcium.

Other types of gallstones detected by gallstone analysis include:

  • Calcium carbonate stones
  • Phosphate stones
  • Protein stones
  • Cystine stones
  • Calcium stearate stones

Based on your health history, symptoms and results of the tests, your doctor will plan the treatment. He will also advise you on diet and lifestyle changes to minimise the risk of gallstone recurrence.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. National Health Service [internet]. UK; Gallstones
  2. Portincasa Piero, Ciaula Agostino Di, Bonfrate Leonilde, and Wang David QH. Therapy of gallstone disease: What it was, what it is, what it will be. World J Gastrointest Pharmacol Ther. 2012 Apr 6; 3(2): 7–20. PMID: 22577615.
  3. Sahajpal AK, Chow SC, Dixon E, Greig PD, Gallinger S, Wei AC. Bile duct injuries associated with laparoscopic cholecystectomy: timing of repair and long-term outcomes. Arch Surg. 2010;145(8):757–763. PMID: 20713928.
  4. Stinton LM, Shaffer EA. Epidemiology of Gallbladder Disease: Cholelithiasis and Cancer. Gut Liver. 2012 Apr; 6(2): 172–187. PMID: 22570746.
  5. Abinash Haziraka, Chandana M.S., Karan Sehgal. Biochemical Analysis of Gallstones in Patients with Calculus Cholecystitis. New Indian Journal of Surgery. 2017; 8(3):320-325.
  6. Hull University Teaching Hospitals [internet]: NHS Foundation Trust. National Health Service. U.K., Laparoscopic Cholecystectomy (removal of the gall bladder using keyhole surgery)
  7. Glasgow RE, Mulvihill SJ (2010). Treatment of gallstone disease. In: M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed., vol. 1, pp. 1121–1138. Philadelphia: Saunders.
  8. Fransisca Putri, Nuri Dyah Indrasari. Gallstone analysis. The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy; Jakarta. 2016 Aug;17(2): 124-130.
  9. Yoo EH, Oh HJ, Lee SY. Gallstone analysis using Fourier transform infrared spectroscopy (FTIR). Clin Chem Lab Med. 2008;46(3):376-81. PMID: 18254703
  10. Sikkandar, S.Jayakumar, S.Gunasekaran, T.S.Renugadevi and B.Alwar. Study on the Analysis of Human Gallstones using Fourier Transform Infrared Spectroscopic Technique. International Journal of ChemTech Research. 2011; 3(1): 149-154.
  11. Tie Qiao, et al. The Systematic Classification of Gallbladder Stones. PLoS One. 2013; 8(10): e74887. PMID: 24124459.
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