Physical-chemical basis of gallstone formation. 1991

J M Donovan, and M C Carey
Harvard Medical School, Boston, Massachusetts.

The broad outlines of the physical chemistry of cholesterol solubilization are well understood, but minor components of native biles probably alter the equilibrium solubility of cholesterol in bile and, more importantly, profoundly affect the kinetics of cholesterol crystal formation. The physical chemistry of UCB solubilization is much less clear; two decades after the limits of cholesterol solubilization in bile were reported, we still cannot provide accurate information on the limits of UCB solubility in bile. Although UCB is predominantly solubilized by the same biliary aggregates as cholesterol, the ionic nature of UCB implies that other, quantitatively minor biliary components profoundly alter UCB solubilization. Understanding UCB solubilization in bile and the prevention of black pigment stone formation await further studies. An understanding of the physical chemistry of cholesterol and UCB, both as solubilized in bile and as precipitated in gallstones, is basic to an understanding of the pathogenesis of gallstone disease, as well as current and potential chemical methods of gallstone dissolution and prevention.

UI MeSH Term Description Entries
D002118 Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Coagulation Factor IV,Factor IV,Blood Coagulation Factor IV,Calcium-40,Calcium 40,Factor IV, Coagulation
D002769 Cholelithiasis Presence or formation of GALLSTONES in the BILIARY TRACT, usually in the gallbladder (CHOLECYSTOLITHIASIS) or the common bile duct (CHOLEDOCHOLITHIASIS). Gallstone Disease,Cholelithiases,Gallstone Diseases
D002784 Cholesterol The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. Epicholesterol
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001647 Bile Acids and Salts Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. Bile Acid,Bile Salt,Bile Salts,Bile Acids,Acid, Bile,Acids, Bile,Salt, Bile,Salts, Bile
D001654 Bile Pigments Linear TETRAPYRROLES that give a characteristic color to BILE including: BILIRUBIN; BILIVERDIN; and bilicyanin. Bile Pigment,Bilin,Pigment, Bile,Pigments, Bile
D001663 Bilirubin A bile pigment that is a degradation product of HEME. Bilirubin IX alpha,Bilirubin, (15E)-Isomer,Bilirubin, (4E)-Isomer,Bilirubin, (4E,15E)-Isomer,Bilirubin, Calcium Salt,Bilirubin, Disodium Salt,Bilirubin, Monosodium Salt,Calcium Bilirubinate,Hematoidin,delta-Bilirubin,Bilirubinate, Calcium,Calcium Salt Bilirubin,Disodium Salt Bilirubin,Monosodium Salt Bilirubin,Salt Bilirubin, Calcium,delta Bilirubin
D050356 Lipid Metabolism Physiological processes in biosynthesis (anabolism) and degradation (catabolism) of LIPIDS. Metabolism, Lipid

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