Biliary sludge

Biliary sludge
Synonyms	Gallbladder sludge, Microcrystalline disease, Biliary sediment, Thick bile, Biliary sand
Pronounce
Field	Gastroenterology
Symptoms
Complications
Onset
Duration
Types
Causes
Risks
Diagnosis
Differential diagnosis
Prevention
Treatment
Medication
Prognosis
Frequency
Deaths

Biliary sludge refers to a viscous mixture of small particles derived from bile.<ref name="Shaffer">,

 Gallbladder sludge: What is its clinical significance?, 
 Current gastroenterology reports, 
 2001,
 Vol. 3(Issue: 2),
 pp. 166–73,
 DOI: 10.1007/s11894-001-0015-6,
 PMID: 11276386,</ref><ref name="Pazzi">, 
 Biliary sludge: The sluggish gallbladder, 
 Digestive and Liver Disease, 
 2003,
 Vol. 35 Suppl 3,
 pp. S39-45,
 DOI: 10.1016/s1590-8658(03)00093-8,
 PMID: 12974509,</ref> These sediments consist of cholesterol crystals, calcium salts, calcium bilirubinate, mucin, and other materials.<ref name="Shaffer"/><ref name="Pazzi"/><ref name="MerckManuals">

Gallbladder and Bile Duct Disorders(link). {{{website}}}. Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

</ref>

Signs and symptoms

Complications

Biliary sludge may cause complications such as biliary colic, acute cholecystitis, acute cholangitis, and acute pancreatitis.<ref name="Shaffer"/><ref name="Pazzi"/>

Cause

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"/>

Pathophysiology

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"/>

Diagnosis

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.

Biliary sludge is typically diagnosed by CT scan or transabdominal ultrasonography.<ref name="Shaffer"/><ref name="Pazzi"/> Endoscopic ultrasonography is another more 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

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, endoscopic sphincterotomy may be performed to reduce the risk of developing pancreatitis.<ref name="Shaffer"/>

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 gallstones.<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

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"/>

See also

• Biliary microlithiasis