What are Different Type of Gall Stones?

What are Different Type of Gall Stones?
  • January 12, 2023
  • blog

Cholecystolithiasis is a widespread condition across the world. Gallstone incidence ranges from 15% in the United States to 5.9-21.9% in Europe, 4-15% in Asia, and 3-11% in China. According to recent studies, the aetiology of various gallstone forms varies. The creation mechanism of various forms of gallstones may be revealed through research on the systematic categorization of gallbladder stones. 

The Various Classifications of Gall Stones and Their Researches

According to the cholesterol content, the types of gallstones were traditionally divided into three kinds: 

  • Cholesterol stones
  • Pigment stones 
  • Mixed stones. 

Later, the types of gallstones were categorised into 8 kinds, in a relatively recent study in 1984 based on the profile structure and chemical components. These included; 

  • Silt-like
  • Black
  • Complicated stones
  • Cast amorphous
  • Radial
  • Radial annular ring-like 
  • Rock strata-like
  • Silt-like stromatolite 

The cast amorphous, sand bed-like, and silt-like stromatolite stones were pigment stones, while the radial, radial annular ring-like, and rock strata-like stromatolite stones were cholesterol stones. 

However, this classification has been overtaken by the previous gallstones classification. They may now be divided into cholesterol stones, pigment stones, mixed stones, and other uncommon stones, courtesy of infrared spectroscopy.

Another classification of gallstone types is systematic categorization. The types  of gallbladder stones may be divided into eight different categories; 

  • Cholesterol 
  • Pigment 
  • Calcium carbonate 
  • Phosphate 
  • Calcium stearate 
  • Protein
  • Cystine 
  • Mixed stones

The next sections will provide a detailed overview of all these types of stones.

The Systematic Categorization of Gallstones Types

  • Cholesterol Stones

Cholesterol stones have a spherical or polyhedron form and can be brownish yellow, amber, grey, celadon, or black in appearance. They were soft, diverse sizes, and either had smooth, shiny, or rough surfaces. The profile had no obvious layers and was yellow, brownish yellow, or white with a darker nucleus and/or radial or radial armillary layered pattern.

Carbon and oxygen made up the majority of the elemental makeup of cholesterol stones, with extremely trace quantities of other elements including calcium, sodium, chlorine, aluminium, magnesium, copper, and silicon. 

Calcium was mostly found in the stone’s core, where it predominantly took the forms of calcium bilirubinate, calcium stearate, or calcium carbonate. Calcium was seldom found in the stone’s outermost layers. 

A few cholesterol stones had a thin coating of calcium carbonate on their surface. Both the core and the surface of these stones had high concentrations of calcium.

  • Pigment Stones

Without a coating, pigment stones were amorphous, brittle granules in the colors of black, charcoal grey, or grayish brown. The coloring stones have a convoluted elemental structure. Along with more than 10 other mineral elements, carbon and oxygen were the two main elements. 

The calcium content, which was mostly present in the form of calcium bilirubinate, was much higher than that of the cholesterol stones. The distribution of calcium in the stone was normally uniform, although it may occasionally be found as calcium carbonate or calcium stearate, which was mostly found in the core and surface.

  • Calcium Carbonate Stones

Calcium carbonate stones were hard or brittle, resembling black coralline, green muck, or black amorphous granules, and lacked any layers.

Since the calcium carbonate crystals were frequently attached to bilirubinate, the calcium, oxygen, and fraction of calcium in the calcium carbonate stones differed from that in the calcium carbonate complex. 

On the surface of the calcium carbonate stones, there were erratic calcium carbonate crystals covered in mucoid material or bilirubinate, and in the core and periphery of the profile, there were calcium carbonate crystals in a variety of shapes, including bulbiform, ellipsoid, fusiform, hawthorn-like, cuboid, button, lamellar, broken firewood-like, rod, and acicular.

  • Phosphate Stones

Phosphate stones had a flat surface, were brittle, and resembled black coal cinders in appearance. Carbon, oxygen, calcium, and phosphorus made up the majority of the constituents in phosphate stones, with a little quantity of additional elements. 

On the surface, bilirubinate-wrapped phosphate particles were present, and the centre and periphery of the profile included echosphere- or rough bulbiform crystals attached to a few bilirubinate particles.

  • Calcium Stearate Stones

Calcium stearate stones had a brick-red profile with no layer, were brittle and uneven in shape, and were either brick red or grey in colour. Calcium stearate stones were primarily composed of carbon, oxygen, and calcium. 

Sulphur, copper, and a trace quantity of other mineral components were frequently found in these stones. These stones had bilirubinate on their surface and a network structure with adhering bilirubinate particles or a tiny number of cholesterol crystals in the profile’s perimeter and centre.

  • Protein Stones 

Protein stones had a rough feel, were green in hue, had mud or clay-like forms, and had no layer. Carbon, oxygen, nitrogen, sulphur, and calcium made up the majority of the components in protein stones, with a little quantity of additional elements. 

On the surface, there were bilirubinate, protein, and/or just several calcium carbonate crystals. In the centre and periphery of the profile, there was a combination of protein and bilirubinate combined with a handful of calcium carbonate crystals.

  • Cystine Stones

Less than 1 mm in size, cystine stones are a distinct kind of gallbladder stone. Cystine stones mostly included the elements carbon, oxygen, nitrogen, and sulphur, along with trace amounts of additional components.

  • Mixed stones 

Mixed stones are those that have two or more different types of material components, each of which has a comparable composition. With the combined components, mixed stones’ elemental concentration and composition vary.

Patients with various stone kinds display different clinical characteristics. Further study reveals that whereas the proportion of male patients with pigment, calcium carbonate, and phosphate stones was greater than that of female patients with cholesterol and calcium stearate stones, the reverse was true for the female patients with cholesterol and calcium stearate stones. 


The percentage of overweight individuals with cholesterol stones was greater than the percentage with pigment and calcium stearate stones, although the percentage with cholesterol, calcium carbonate, and mixed stones was lower. This implies that various stone kinds could have various stone creation mechanisms. Therefore, following surgery, the gallstones of cholelithiasis patients should be thoroughly evaluated and recognised. 

At Santokh Hospital, we deliver the right diagnosis and treatment for different types of gallstones. Our dedicated healthcare experts provide recommendations for preventing the incidence of gallstones.