Calculus (Stone) Analysis by automated FTIR (Gall bladder calculus)

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Chemical composition analysis of gallstones.

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Calculus (Stone) Analysis by Automated FTIR - Gallbladder Calculus

Why is it done?
- Identifies the chemical composition of gallbladder stones to determine their nature and etiology
- Determines whether stones are cholesterol-based, pigment-based (bilirubin), calcified, or mixed composition
- Helps guide clinical management decisions and assess risk of complications such as pancreatitis or cholecystitis
- Performed after stone extraction via surgical choledochotomy, endoscopic sphincterotomy, or cholecystectomy
- Provides information for understanding underlying metabolic abnormalities and recurrence prevention
- Used in research and epidemiological studies to characterize stone disease patterns
Normal Range
- This is a qualitative analytical test, not a quantitative measurement; therefore, 'normal range' is not applicable
- Results are reported as the identified chemical composition of the stone:
- Cholesterol Monohydrate - Primary component of cholesterol stones (most common type, >80% in Western populations)
- Bilirubin (Unconjugated/Conjugated) - Component of pigment stones, associated with hemolysis or cirrhosis
- Calcium Bilirubinate - Brown pigment stone component, found in hemolytic disease
- Calcium Carbonate/Phosphate - Calcified components, associated with chronic inflammation
- Mixed Composition - Combination of multiple components
- Measured by automated Fourier Transform Infrared (FTIR) Spectroscopy, which detects specific infrared absorption patterns characteristic of each compound
- Results typically reported as percentage composition of each identified component
Interpretation
- Cholesterol Stones (>50% cholesterol):
  - Most common type of gallstone accounting for 80-95% of stones in developed countries
  - Risk factors include obesity, female gender, family history, rapid weight loss, diabetes, and hyperlipidemia
  - Generally have lower recurrence rate after treatment with appropriate management
- Pigment Stones (Brown/Black):
  - Comprise 5-20% of gallstones; contain high levels of bilirubin and calcium bilirubinate
  - Black pigment stones: Associated with hemolytic disease (hereditary spherocytosis, sickle cell disease), cirrhosis, and chronic hemolysis
  - Brown pigment stones: Associated with bile duct obstruction, recurrent cholangitis, and parasitic infections
  - Higher risk of complications including acute cholangitis and cholecystitis
- Calcified Stones:
  - Contain calcium carbonate or phosphate; indicate chronic inflammation of the gallbladder
  - 'Porcelain gallbladder' (calcified gallbladder wall) associated with increased risk of gallbladder carcinoma
- Mixed Composition Stones:
  - Contain multiple components reflecting complex pathophysiology; interpretation depends on predominant component
- Factors Affecting Results:
  - Sample size and selection: Multiple stones from same patient may have varying composition
  - Stone location within specimen: Core vs. surface may have different composition
  - Preservation and handling of specimen may affect accuracy
Associated Organs
- Primary Organ - Gallbladder:
  - The gallbladder is a small organ beneath the liver that stores and concentrates bile for digestion
- Secondary Associated Organs/Systems:
  - Liver - Produces bile; underlying liver disease can contribute to stone formation
  - Common bile duct - May be obstructed by migrating stones causing cholangitis or pancreatitis
  - Pancreas - Pancreatic duct obstruction by stones can cause acute pancreatitis
- Medical Conditions Associated with Abnormal Results:
  - Cholelithiasis (gallstone disease)
  - Acute cholecystitis (gallbladder inflammation)
  - Choledocholithiasis (common bile duct stones)
  - Acute cholangitis (bile duct infection)
  - Acute pancreatitis (stone-induced obstruction of pancreatic duct)
  - Hemolytic anemia (predisposes to pigment stone formation)
  - Cirrhosis and chronic liver disease (increased pigment stone risk)
  - Crohn's disease (affects bile acid metabolism)
  - Metabolic syndrome and obesity (cholesterol stone formation)
  - Cystic fibrosis (bile abnormalities)
  - Gallbladder carcinoma (particularly with porcelain gallbladder)
- Potential Complications Associated with Abnormal Results:
  - Acute pancreatitis (most common serious complication)
  - Gallbladder perforation and peritonitis
  - Septic cholecystitis with sepsis
  - Bilioenteric fistula and gallstone ileus
  - Obstructive jaundice from bile duct occlusion
  - Recurrent gallstone formation and cholangitis (if stone composition indicates ongoing metabolic risk)
Follow-up Tests
- Based on Pigment Stone Results:
  - Complete blood count (CBC) to evaluate for hemolytic anemia
  - Reticulocyte count to assess bone marrow response to hemolysis
  - Bilirubin levels (total and direct) to evaluate hepatic function and hemolysis
  - Liver function tests (AST, ALT, ALP, GGT) to assess for cirrhosis
  - Hemoglobin electrophoresis if sickle cell disease suspected
  - Abdominal ultrasound to assess for residual stones or biliary tract abnormalities
- Based on Cholesterol Stone Results:
  - Lipid panel (total cholesterol, LDL, HDL, triglycerides)
  - Fasting glucose or HbA1c for diabetes screening
  - BMI assessment and metabolic evaluation
- Based on Calcified Stone/Porcelain Gallbladder Results:
  - CT or MRI abdomen to assess for gallbladder carcinoma risk
  - Tumor markers (CEA, CA 19-9) if malignancy suspected
- If Complications Suspected:
  - Lipase and amylase if pancreatitis suspected
  - MRCP (Magnetic Resonance Cholangiopancreatography) for biliary obstruction
  - ERCP (Endoscopic Retrograde Cholangiopancreatography) with stone extraction if indicated
- Monitoring Frequency:
  - Asymptomatic patients: Routine follow-up based on risk factors; typically 6-12 months initially
  - High-risk patients with pigment stones: More frequent monitoring with imaging
  - Post-ERCP or surgical intervention: Follow-up imaging in 4-6 weeks to confirm stone clearance
Fasting Required?
- No - Fasting is NOT required for gallstone analysis
- This is an analytical test performed on extracted or surgically removed stone specimens, not a blood test or imaging study
- Fasting status of the patient does not affect stone composition analysis
- Sample Collection Requirements:
  - Stones are collected during cholecystectomy (surgical removal of gallbladder), ERCP (endoscopic stone extraction), or other biliary interventions
  - Stones should be placed in a sterile, dry container without preservatives
  - Proper labeling with patient identifiers, date, and time of collection is essential
  - Stones should be kept dry; moisture or contamination may affect analysis accuracy
  - Multiple stones can be analyzed; analysis may be performed on representative specimens or individual stones
- Medications:
  - No specific medication restrictions for stone analysis itself
  - However, medications may need to be held before the surgical or endoscopic procedure used to obtain the stones (per surgeon/endoscopist instructions)
- Other Patient Preparation:
  - Preparation depends on the procedure used to obtain stones (surgery vs. endoscopy)
  - For elective cholecystectomy: Standard NPO (nothing by mouth) status for 6-8 hours before surgery
  - For ERCP: NPO for 2-4 hours; may require conscious sedation preparation
  - Informed consent required for both diagnostic and therapeutic procedures

How our test process works!