Page 175 - Color Atlas Of Pathophysiology (S Silbernagl Et Al, Thieme 2000)

A. Cholelithiasis: Abnormal Cholesterol to Bile Salt Ratio

Liver Acetyl-CoA
HMG-CoA
reductase
Enterohepatic Bile salts
circulation New synthesis
Cholesterol
Gallbladder
crystals
HO Cholesterol
Duodenum Vesicles
Progesteron
Ileum
1 ACAT
Phosphati- Cholelithiasis I
dylcholine
Cholesterol
Fasting Crohn’s disease, Unbalanced ester
(over night!), intestinal re- diet
section
parenteral diet Plate 6.16
2 VLDL
Bile salt Phosphatidyl-
Bile salt loss choline
sequestration Cholesterol secretion
Bile salts Phosphatidyl- Cholesterol
choline
Bile

3
4 Dissociation:
100 cholesterol Supersaturation
crystals
Cholesterol (%mol) 60 40 Crystal formation
20
80

40 60
‘Super
saturated’
Phosphatidylcholine (%mol)
20 Micellar Cholesterol stones
solution
0 (after Small et al.)
100 80 60 40 20 0
Bile salts (%mol) 165
Silbernagl/Lang, Color Atlas of Pathophysiology © 2000 Thieme
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