Abnormalities in bile constituents
Cholesterol and mixed gallstones may precipitate out of solution owing to a rise in cholesterol or a decrease in bile salts.
Factors associated with a rise in cholesterol include:
- obesity
- age } especially between puberty
- female sex } menopause in women
- drugs such as oral contraceptives, clofibrate
Factors associated with a decrease in bile salts include:
- any interruption to the enterohepatic circulation, e.g.:
- gastrointestinal disease
- small bowel or ileal resection or bypass
- cholestyramine therapy
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