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There are many events that may promote cholelithiasis:
• The liver secretes too much cholesterol into the bile.
• The gallbladder may not be able to empty normally, so bile becomes stagnant.
• The cells lining the gallbladder may not be able to efficiently absorb cholesterol and fat from bile.
• There are high levels of bilirubin. Bilirubin is a substance normally formed by the breakdown of hemoglobin in the blood. It is removed from the body in bile. Some experts believe bilirubin may play an important role in the formation of cholesterol gallstones.
Pigment Stones. Pigment stones are composed of calcium bilirubinate, or calcified bilirubin. Pigment stones can be black or brown.
• Black stones form in the gallbladder and are the more common type. They represent 20% of all gallstones in the U.S. They are more likely to develop in people with hemolytic anemia (a relatively rare anemia in which red blood cells are destroyed) or cirrhosis (scarred liver).
• Brown pigment stones are more common in Asian populations. They contain more cholesterol and calcium than black pigment stones and are more likely to occur in the bile ducts. Infection plays a role in the development of these stones.
Mixed stones. Mixed stones are a mixture of cholesterol and pigment stones.

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