Gall-stones and diseases of the bile-ducts . Fig. 11.—A group of bilirubin-calcium gall-stones. considerable quantities, biliverdin-calcium and bili-fuscin : cholesterin is present in minute quantity. (6) Rarer Forms.— (a) Amorphous and incompletelycrystalline cholesterin gravel. — These vary in sizefrom a grain of sand to that of a large pea, and often. Fig. 12.—Gall-stones composed of chalk. (Calcium carbonate). look like pearls. They have a nucleus of bilirubin-calcium enclosed in cholesterin. (b) Calcium carbonate calculi (calcareous stones).—These are rare. The museum of the Middlesex 48
Gall-stones and diseases of the bile-ducts . Fig. 11.—A group of bilirubin-calcium gall-stones. considerable quantities, biliverdin-calcium and bili-fuscin : cholesterin is present in minute quantity. (6) Rarer Forms.— (a) Amorphous and incompletelycrystalline cholesterin gravel. — These vary in sizefrom a grain of sand to that of a large pea, and often. Fig. 12.—Gall-stones composed of chalk. (Calcium carbonate). look like pearls. They have a nucleus of bilirubin-calcium enclosed in cholesterin. (b) Calcium carbonate calculi (calcareous stones).—These are rare. The museum of the Middlesex 48 DISEASES OF THE BILE-DUCTS Hospital contains a set of twenty spiculated chalk(calcium carbonate) stones removed from the gall-bladder after death. (c) Concretions with included bodies.—Grall-stonesnot infrequently have a nucleus which may berecognised as an independent calculus. Such maybe called conglomerate gall-stones. Foreign bodies, such as a round worm or a portionof a fluke, a needle, and a plum-stone, have beenfound in gall-stones. (d) Casts of bile-ducts.—These are rare in consist of pure bilirubin-calcium, and amongthe small calculi composed of this material there arealways some which are hollow and are actually castsof the smaller bile-ducts. From this it will be seen that cholesterin andbilirubin-calcium are the most
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