Gallstones form as the culmination of a complex series of events that results in precipitation of insoluble substances including cholesterol or bilirubin in the gallbladder. Bile formation is essential for lipid digestion and the removal of excess cholesterol from the body either by direct excretion or after conversion to bile acids. Gallstones occur when insoluble lipids and inorganic salts secreted by the liver cannot be solubilized as they normally are in bile by the detergent properties of bile salts. For this to occur, metabolic events must take place to produce bile that contains excess amounts of either cholesterol or bilirubin (supersaturation), both of which are relatively insoluble in aqueous solution. Additionally, physical factors must allow rapid nucleation within the residence time of bile in the biliary tree.
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