Question
The following conditions are associated with high incidence of pigment gallstones except:
| A. |
Cirrhosis |
| B. |
Ileal disease |
| C. |
Thalassemia |
| D. |
Prosthetic heart valve |
Show Answer
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Correct Answer » B Explanation |
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Pigment gallstones are composed mainly of calcium bilirubinate and are associated with conditions that increase bilirubin production or promote bilirubin precipitation.
Conditions associated with pigment gallstones
- Cirrhosis → increased unconjugated bilirubin load and altered bile composition.
- Thalassemia → chronic hemolysis causes excess bilirubin production.
- Prosthetic heart valve → mechanical hemolysis increases bilirubin production.
- Other hemolytic states such as hereditary spherocytosis and sickle cell disease are also associated with pigment stones.
Ileal Disease
Ileal disease (e.g., Crohn’s disease or ileal resection) causes malabsorption of bile salts, leading to decreased bile salt pool and supersaturation of bile with cholesterol.
Therefore, ileal disease is classically associated with cholesterol gallstones, not pigment gallstones.
Key Association
| Condition | Type of Gallstone |
|---|---|
| Cirrhosis | Pigment stones |
| Thalassemia | Pigment stones |
| Prosthetic heart valve | Pigment stones |
| Ileal disease | Cholesterol stones |