Cholestasis

Introduction Bile stasis is an imaging diagnosis. The early stage of most gallstones can be characterized by biliary stasis and subsequent formation of bile and stones. There is a certain relationship with the long-term lack of regularity in eating breakfast.

Cause

The basis of the formation of cholesterol stones is the imbalance of the contents of cholesterol, bile acid and lecithin in the bile, which causes the cholesterol in the bile to be supersaturated and crystallize, precipitate, aggregate and form stones. Most of the cholesterol in bile is derived from the biosynthesis of liver cells, not the secretion of cholesterol in the diet. The formation of cholesterol stones is mainly due to the supersaturation of cholesterol in the bile synthesized by hepatocytes, and the nucleation of protein cholesterol-promoting crystals in bile. The other factors are attributed to the dysfunction of gallbladder motor function, which together act. Bile stasis, promote the formation of gallstones.

an examination

Related inspection

CT, T-tube angiography of liver, gallbladder and spleen

The white blood cell count was significantly increased, the urinary tricholic abnormalities, elevated blood bilirubin, and abnormal liver function (such as ALT, AST, r-GT, ALP, etc.) increased to varying degrees. B-ultrasound, CT examination showed gallbladder enlargement, bile duct expansion and calculus, ERCP, PTC examination can more clearly show the lesions inside and outside the bile duct. Should pay attention to check the function of liver and gallbladder, check blood, urine, to see if there is abnormal diarrhea.

Differential diagnosis

Differential diagnosis of biliary stasis:

(1) Cholesterol stones: The main component of the stone is cholesterol, mostly oval (single-shot) or multi-faceted (multiple), the surface is smooth or slightly nodular, yellow or yellowish white, soft and soft, the profile is Radial line pattern, not developed on X-ray film. Such stones are mostly in the gallbladder, often single, large in size and up to several centimeters in diameter. Such stones are less in Europe than in Europe and America, and their incidence rate does not exceed 20% of cholelithiasis.

(2) bile pigmented stones: the stone components are mainly bilirubin calcium, which may contain a small amount of cholesterol. Mostly sand-like, soft and brittle, some like mud-like, some like sand, brown or brown-red, varying in size. Because of the low calcium content, the X-ray film does not develop much. Sand grain size is 1 ~ 10mm, often more than one, mostly in the liver and the outer bile duct.

(3) Mixed stones: They are formed by separating two or more main components such as cholesterol, bile pigment, and calcium salt. It has different shapes and is multi-faceted particles with smooth surface, rounded edges, dark green or brown, and the cut surface is ring-shaped or like a tree trunk or radial. Due to the high calcium content, it is sometimes developed on X-ray films (ie, positive stones). More in the gallbladder, can also be found in the larger bile duct, the size, the number varies, often more than one, usually 20 to 30. Mixed cholelithiasis-based mixed gallstones are the most common in China, accounting for more than 90% of all cholelithiasis cases.

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