Biliary sludge: Difference between revisions

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{{Infobox medical condition (new)
{{Short description|A mixture of particulate matter in the bile}}
| name            = Biliary sludge
{{Use dmy dates|date=October 2023}}
| synonyms        = Gallbladder sludge, Microcrystalline disease, Biliary sediment, Thick bile, Biliary sand
| image          = Ultrasonography of sludge and gallstones, annotated.jpg
| caption        = [[Abdominal ultrasonography]] showing biliary sludge and gallstones
| pronounce      =
| field          = [[Gastroenterology]]
| symptoms        =
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| onset          =
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| types          =
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| risks          =
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| prevention      =  
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'''Biliary sludge''' refers to a viscous mixture of small particles derived from [[bile]].<ref name="Shaffer">{{Cite journal | pmid = 11276386| year = 2001| author1 = Shaffer| first1 = E. A.| title = Gallbladder sludge: What is its clinical significance?| journal = Current gastroenterology reports| volume = 3| issue = 2| pages = 166–73| doi=10.1007/s11894-001-0015-6}}</ref><ref name="Pazzi">{{Cite journal | pmid = 12974509| year = 2003| author1 = Pazzi| first1 = P| title = Biliary sludge: The sluggish gallbladder| journal = Digestive and Liver Disease| volume = 35 Suppl 3| pages = S39-45| last2 = Gamberini| first2 = S| last3 = Buldrini| first3 = P| last4 = Gullini| first4 = S| doi=10.1016/s1590-8658(03)00093-8}}</ref> These sediments consist of [[cholesterol]] crystals, [[calcium]] salts, calcium [[bilirubin]]ate, [[mucin]], and other materials.<ref name="Shaffer"/><ref name="Pazzi"/><ref name="MerckManuals">{{cite web |url=http://www.merckmanuals.com/professional/hepatic_and_biliary_disorders/gallbladder_and_bile_duct_disorders/cholelithiasis.html |title=Gallbladder and Bile Duct Disorders |publisher=Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc |accessdate=15 January 2015}}</ref>
'''Biliary sludge''' is a mixture of particulate matter and mucus that forms in the [[bile]]. It is often detected incidentally during [[ultrasound]] examinations of the [[gallbladder]] and is considered a precursor to [[gallstones]].


==Signs and symptoms==
==Composition==
===Complications===
Biliary sludge is composed of a mixture of [[cholesterol]] crystals, [[calcium bilirubinate]], and other calcium salts. These components are suspended in [[bile]], a digestive fluid produced by the [[liver]] and stored in the gallbladder. The sludge forms when there is an imbalance in the composition of bile, leading to the precipitation of these particles.
Biliary sludge may cause complications such as [[biliary colic]], [[acute cholecystitis]], [[acute cholangitis]], and [[acute pancreatitis]].<ref name="Shaffer"/><ref name="Pazzi"/>


==Cause==
==Causes==
Biliary sludge has been associated with [[pregnancy]], rapid weight loss, [[total parenteral nutrition]], drugs such as [[ceftriaxone]] and [[octreotide]], solid [[organ transplantation]], and gastric surgery.<ref name="Shaffer"/><ref name="Pazzi"/> In many of these conditions, it is thought that the impairment in the contractility of the gallbladder leads to the formation of the sludge.<ref name="Pazzi"/>
Several factors can contribute to the formation of biliary sludge, including:


==Pathophysiology==
* '''Prolonged fasting''': Reduced gallbladder motility during fasting can lead to bile stasis and sludge formation.
The pathophysiology of biliary sludge formation is likely related to gallbladder dysmotility.<ref name="Pazzi"/> It is presumed that because the gallbladder is unable to effectively empty, the biliary sludge can start to accumulate.<ref name="Pazzi"/>
* '''Pregnancy''': Hormonal changes during pregnancy can alter bile composition and gallbladder function.
* '''Rapid weight loss''': This can lead to increased cholesterol secretion into bile.
* '''Total parenteral nutrition (TPN)''': Lack of enteral stimulation can result in gallbladder stasis.
* '''Certain medications''': Drugs such as [[ceftriaxone]] can precipitate in bile and form sludge.
 
==Symptoms==
Biliary sludge is often asymptomatic and discovered incidentally. However, it can cause symptoms similar to those of [[biliary colic]] if it leads to obstruction of the [[cystic duct]] or [[common bile duct]]. Symptoms may include:
 
* [[Abdominal pain]]
* [[Nausea]]
* [[Vomiting]]
* [[Jaundice]]


==Diagnosis==
==Diagnosis==
[[File:Gallbladder hepatization.jpg|thumb|Gallbladder hepatization, which is biliary sludge filling the entire gallbladder, giving it an [[echogenicity]] similar to the [[liver]] (seen at left). The patient had a stone in the [[cystic duct]].]]
The primary method for diagnosing biliary sludge is [[ultrasonography]]. On ultrasound, sludge appears as low-level echoes within the bile that do not cast an acoustic shadow, unlike gallstones. In some cases, [[endoscopic ultrasound]] (EUS) or [[magnetic resonance cholangiopancreatography]] (MRCP) may be used for further evaluation.
Biliary sludge is typically diagnosed by [[CT scan]] or [[transabdominal ultrasonography]].<ref name="Shaffer"/><ref name="Pazzi"/> [[Endoscopic ultrasound|Endoscopic ultrasonography]] is another more [[Sensitivity and specificity|sensitive]] option. However, the [[gold standard]] is considered to be direct microscopy of aspirated gallbladder bile.<ref name="Shaffer"/><ref name="Pazzi"/> This method is much more sensitive, although it is less practical.<ref name="Pazzi"/>


==Treatment==
==Treatment==
For patients without symptoms, no treatment is recommended. If patients become symptomatic and/or develop complications, [[cholecystectomy]] is indicated.<ref name="Shaffer"/> For those who are poor surgical candidates, [[Endoscopy|endoscopic]] sphincterotomy may be performed to reduce the risk of developing [[pancreatitis]].<ref name="Shaffer"/>
Management of biliary sludge depends on the presence and severity of symptoms. Asymptomatic sludge often requires no treatment and may resolve spontaneously. In symptomatic cases, treatment options include:
 
==Prognosis==
The clinical course of biliary sludge can do one of three things: (1) it can resolve completely, (2) wax and wane, or (3) progress to [[gallstone]]s.<ref name="Shaffer"/><ref name="Pazzi"/><ref name="MerckManuals"/> If the biliary sludge has a cause (e.g. pregnancy), it oftentimes is resolved when the underlying cause is removed.<ref name="MerckManuals"/>


==Epidemiology==
* '''Cholecystectomy''': Surgical removal of the gallbladder may be considered if sludge is associated with recurrent symptoms or complications.
The prevalence of biliary sludge is low in the general population.<ref name="Pazzi"/> It has been reported that the prevalence ranges from 0-0.20% in men and 0.18-0.27% in women.<ref name="Pazzi"/> However, in patients with certain conditions, the prevalence may be higher.<ref name="Pazzi"/>
* '''Ursodeoxycholic acid''': This medication can help dissolve cholesterol crystals and improve bile flow.


==See also==
==Complications==
*[[Biliary microlithiasis]]
If left untreated, biliary sludge can lead to complications such as:


==References==
* [[Cholecystitis]]: Inflammation of the gallbladder.
{{reflist}}
* [[Pancreatitis]]: Inflammation of the [[pancreas]], particularly if sludge obstructs the pancreatic duct.
* [[Choledocholithiasis]]: Formation of stones in the common bile duct.


== External links ==
==Related pages==
{{Medical resources
* [[Gallstones]]
|  DiseasesDB    = 
* [[Cholecystitis]]
|  ICD10          = {{ICD10|K|83|9|k|80}}
* [[Pancreatitis]]
|  ICD9          = {{ICD9|576.8}}
* [[Bile]]
|  ICDO          = 
|  OMIM          = 
|  MedlinePlus    = 
|  eMedicineSubj  = 
|  eMedicineTopic = 
|  MeshID        =
}}
{{Use dmy dates|date=April 2017}}


[[Category:Medical terminology]]
[[Category:Hepatology]]
[[Category:Disorders of gallbladder, biliary tract and pancreas]]
[[Category:Gastroenterology]]

Revision as of 19:22, 22 March 2025

A mixture of particulate matter in the bile



Biliary sludge is a mixture of particulate matter and mucus that forms in the bile. It is often detected incidentally during ultrasound examinations of the gallbladder and is considered a precursor to gallstones.

Composition

Biliary sludge is composed of a mixture of cholesterol crystals, calcium bilirubinate, and other calcium salts. These components are suspended in bile, a digestive fluid produced by the liver and stored in the gallbladder. The sludge forms when there is an imbalance in the composition of bile, leading to the precipitation of these particles.

Causes

Several factors can contribute to the formation of biliary sludge, including:

  • Prolonged fasting: Reduced gallbladder motility during fasting can lead to bile stasis and sludge formation.
  • Pregnancy: Hormonal changes during pregnancy can alter bile composition and gallbladder function.
  • Rapid weight loss: This can lead to increased cholesterol secretion into bile.
  • Total parenteral nutrition (TPN): Lack of enteral stimulation can result in gallbladder stasis.
  • Certain medications: Drugs such as ceftriaxone can precipitate in bile and form sludge.

Symptoms

Biliary sludge is often asymptomatic and discovered incidentally. However, it can cause symptoms similar to those of biliary colic if it leads to obstruction of the cystic duct or common bile duct. Symptoms may include:

Diagnosis

The primary method for diagnosing biliary sludge is ultrasonography. On ultrasound, sludge appears as low-level echoes within the bile that do not cast an acoustic shadow, unlike gallstones. In some cases, endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) may be used for further evaluation.

Treatment

Management of biliary sludge depends on the presence and severity of symptoms. Asymptomatic sludge often requires no treatment and may resolve spontaneously. In symptomatic cases, treatment options include:

  • Cholecystectomy: Surgical removal of the gallbladder may be considered if sludge is associated with recurrent symptoms or complications.
  • Ursodeoxycholic acid: This medication can help dissolve cholesterol crystals and improve bile flow.

Complications

If left untreated, biliary sludge can lead to complications such as:

Related pages

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