Morphological spectrum of gallstone and bacteriology of bile in patient of cholelithiasis visiting tertiary care centre in North India

Authors

  • Himank Gandhi Department of Surgery, Sri Guru Ram Das Institutes of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab http://orcid.org/0000-0002-2885-2112
  • Gopal Swaroop Bhargava Department of Surgery, Sri Guru Ram Das Institutes of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab
  • Darpan Bansal Department of Surgery, Sri Guru Ram Das Institutes of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab
  • Karaninder Singh Department of Surgery, Sri Guru Ram Das Institutes of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab

DOI:

https://doi.org/10.18203/2349-2902.isj20205821

Keywords:

Bacteriological profile, Bile culture, Gallstone

Abstract

Background: Calculus biliary tract disease continues to be a major health concern. It is normal to see predisposing factors such as cirrhosis, ileal resection in the West; while infection predominates in South East Asia as a cause. We prospectively examined gall stones in this study to investigate the causes and role of bacteria in the disease of gall stone disease.

Methods: This is a cross sectional study conducted in department of surgery, Sri Guru Ram Das University of Health Sciences, Sri Amritsar, India, from November 2018-August 2020. Total 50 cases were selected and operated by lap/open cholecystectomy were included in this study. During cholecystectomy bile was aspirated and was sent to laboratory for culture. Gallstone retrieved from the specimen was classified based on morphological appearance.

Results: Gallstone disease found to be common in female 92% and in the age group of 4-50 years. Bile of gallstones patients is often infected. In this study though morphologically cholesterol stones were commonest but mixed stones were associated with highest infection rates. Most common bile infecting bacterium in all kinds of stones was found to be E. coli 60.8% followed by klebsiella 17.3% and proteus 17.3%. All the organisms cultured were sensitive to cephalosporins, quinolones, aminoglycosides and penicillin group of antibiotics.

Conclusions: Bile culture was positive in 46% of the cases. Morphologically cholesterol stones were commonest 52% but mixed stones were associated with highest infection rates (80%). Most common bile infecting bacterium in all kinds of stones was found to be E. coli.  

Author Biography

Himank Gandhi, Department of Surgery, Sri Guru Ram Das Institutes of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab

SURGERY DEPARTMENT,POST GRADUATE

References

Johnston DE, Kalpan MM. Pathogenesis and treatment of gallstone. New Eng J Med. 1993;328:412-21.

Small DM. Cholesterol nucleation and growth in gallstone formation. N Eng J Med. 1980;302;130511

Cuschieri A. Disorder of the biliary tract. In: Text book of surgery. 4th ed. Philadelphia: Arnold Publication. 2002:375-453.

Tandon R. Diseases of Gall Bladder and Biliary Tract. In: API Textbook of Medicine, Shah SN, ed. 9th ed. Mumbai: API Publications; 2012:911.

Conte D, Fraquelli M, Giunta M, Conti CB. Gall stones and Liver disease: an overview. J Gastrointest Liv Dis. 2011;20(1):9-11.

Maki T. Pathogenesis of calcium bilirubinate gallstone: role of E. coli, beta-glucuronidase and coagulation by inorganic ions, polyelectrolytes and agitation. Ann Surg. 1966;164(1):90.

Blanckaert N, Compernolle F, Leroy P, Van Houtte R, Fevery J, Heirwegh KP. The fate of bilirubin-IXα glucuronide in cholestasis and during storage in vitro. Intramolecular rearrangement to positional isomers of glucuronic acid. Biochem J. 1978;171(1):203-14.

Masuda H, Nakayama F. Composition of bile pigment in gallstones and bile and their etiological significance. J Laborat Clinic Medic. 1979;93(3):353-60.

Smith BF, LaMont JT. Bovine gallbladder mucin binds bilirubin in vitro. Gastroenterology. 1983;85(3):707-12.

Skar V, Saxerholt H. High-Performance Liquid Chromatography of Bilirubin Conjugates in Bile: Effect of β-Glucuronidase on the Bile Pigments. Scandina J Gastroenterol. 1989;24(6):657-65.

Skar V, Skar AG, Bratlie J, Osnes M. Beta-glucuronidase activity in the bile of gallstone patients both with and without duodenal diverticula. Scandinav J Gastroenterol. 1989;24(2):205-12.

Carey MC. Pathogenesis of gallstones. Am J Surg. 1993;165(4):410-9.

Cetta F, Lombardo F. The possible role of phospholipase in gallstone pathogenesis. Gastroenterology. 1991;101(2):592-3.

Robins SJ, Fasulo JM, Patton GM. Lipids of pigment gallstones. Lip Lip Metabol. 1982;712(1):21-5.

Nakano T, Yanagisawa J, Nakayama F. Phospholipase activity in human bile. Hepatology. 1988;8(6):1560-4.

Akiyoshi T, Nakayama F. Bile acid composition in brown pigment stones. Digest Diseas Sci. 1990;35(1):27-32.

Bouchier IA, Cooperband SR, El Kodsi BM. Mucous substances and viscosity of normal and pathological human bile. Gastroenterology. 1965;49(4):343-53.

Maki T, Matsushiro T, Suzuki N, Nakamura N. Role of sulfated glycoprotein in gallstone formation. Surg Gynecol Obstet. 1971;132(5):846.

LaMont JT, Turner BS, DiBenedetto DI, Handin RO, Schafer AI. Arachidonic acid stimulates mucin secretion in prairie dog gallbladder. Am J Physiol. 1983;245(1):G92-8.

Lamont JT, Smith BF, Moore JR. Role of gallbladder mucin in pathophysiology of gallstones. Hepatology. 1984;4(S2):51S-6S.

Yeh HZ, Chen GH, Cheng YP, Wu CC, Liu TJ. The analysis of stone formation factors in bile juice: Emphasis on bile viscosity and mucin glycoprotein. Clin J Gastroeneterol. 1993;10(2):149-56.

Afdhal NH, Smith BF. Cholesterol crystal nucleation: A decade‐long search for the missing link in gallstone pathogenesis. Hepatology. 1990;11(4):699-702.

Lee SP. Hypersecretion of mucus glycoprotein by gallbladder epithelium in experimental cholelithiasis. J Pathol. 1981;134:199-207.

Sheen PC, Lee KT, Liu YE. Mucin Content in Gallbladderswith Brown Pigment Stones orCombination Stones with a Brown Periphery. Digestion. 1998;59(6):660-4.

Inoue T, Mishima Y. The pathophysiological characteristics of bile from patients with gallstones: the role of prostaglandins and mucin in gallstone formation. Japan J Surg. 1990;20(1):10-8.

Kuver R, Savard C, Oda D, Lee SP. PGE generates intracellular cAMP and accelerates mucin secretion by cultured dog gallbladder epithelial cells. Am J Physiol Gastrointest Liver Physiol. 1994;267(6):G998-1003.

Csendes A, Mitru N, Maluenda F, Diaz JC, Burdiles P, Csendes P, et al. Counts of bacteria and pyocites of choledochal bile in controls and in patients with gallstones or common bile duct stones with or without acute cholangitis. Hepato-gastroenterology. 1996;43(10):800-6.

Osnes T, Sandstad O, Skar V, Osnes M. Lipopolysaccharides and beta-glucuronidase activity in choledochal bile in relation to choledocholithiasis. Digestion. 1997;58(5):437-43.

Choi J, Klinkspoor JH, Yoshida T, Lee SP. Lipopolysaccharide from Escherichia coli stimulates mucin secretion by cultured dog gallbladder epithelial cells. Hepatology. 1999;29(5):1352-7.

Zuhair R, Bahrani A, Mohammad R, Saleh AL. Prevalence and morphology and chemical composition of gallstones. Iraqi Post Graduate Medical J. 2011;10:1.

Ranshoff DF, Gracie WA. The natural history of silent gallstones: the innocent gallstone is not a myth. N Eng J Med. 1982:307:798-800.

Khedkar I, Prasad D, Datta A. Diagnostic value of upper gastrointestinal endoscopy prior to elective laparoscopic cholecystectomy for symptomatic cholelithiasis. Int Surg J. 2018;5:105-9.

Tandon RK. Prevalence and type of biliary stones in India. World J Gastroenterol. 2000;6(Suppl 3):4-5.

Gupta AM, Ramteke S, Kanwar KS, Soni P. Study of morphological spectrum of gallstone and bacteriology of bile in cholelithiasis. Int Surg J. 2017;4:177-80.

Yaqin H, Sultan G. Results of culture of gallbladder, bile and gall-stones. J Pak Med Assoc. 1978;28:312.

Guo RX, He SG, Shen K. The bacteriology of cholelithiasis. Japan J Surg. 1991;21:606-12

Ohdan H, Oshiro H, Yamamoto Y, Tanaka I, Inagaki K, Sumimoto K, et al. Bacteriological investigation of bile in patients with cholelithiasis. Surg Today. 1993;23(5):390-5.

Sabir O. Infected bile in gallbladder in cholelithiasis dissertation. Karachi: College of Physicians and Surgeon Pakistan. 1998.

Cuschieri A, Bouchier IAD. The biliary tract. In: Cuschieri A, Giles GR, Moosa AR. Essential surgical practice. 2nd ed. Edinburgh: Butterworth Heienemann. 1988:1020-75.

Ballal M. Bacteriological spectrum of cholecystitis and its antibiogram. Ind J Med Microbiol. 2001;19:212-4.

Downloads

Published

2020-12-28

Issue

Section

Original Research Articles