Diseases of bile duct in children

Table 7 Characteristics of cholesterol and pigmented gallstones in children[150,152]

	Cholesterol stones	Pigmented stones
		Brown	Black
Mechanism	Hypersecretion of cholesterol. Increased mucin production. Decreased gallbladder motility	Biliary tract infected with bacteria producing β-glucuronidase. Excess bilirubin glucuronides in bile to unconjugated bilirubin or phospholipase A1 hydrolysis of biliary phosphatidylcholines that creates calcium salts	Increased bilirubin production. Decreased enterohepatic circulation (ileal disease) of the endogenous bile salt pool
Content	Cholesterol (50%), glycoprotein and minimal calcium salts	Calcium bilirubinate (60%), calcium palmitate and stearate (15%), cholesterol (15%), and mucin glycoprotein (10%)	Bile-pigmented polymer (40%), calcium carbonate or phosphate salts (15%), and cholesterol (5%)
Risk factor	Obesity, adolescence, Hispanic ethnicity, female, and family history	Bacterial (E.coli) or parasitic infection, bile duct anomaly, and birth control pills	Hemolytic anemia, cirrhosis, TPN, ceftriaxone, and ileal resection
Age	Puberty increases with age	Any	Any
Size, number	Solitary 2-4 cm. Multiple < 5 mm	Vary	Multiple 1-3 cm
Radiopaque	No	No	Yes (50%)
Recurrent	Yes	Yes	No

E.coli: Escherichia coli; TPN: Total parenteral nutrition.