Biliary sludge
| Biliary sludge | |
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| Synonyms | Gallbladder sludge, Microcrystalline disease, Biliary sediment, Thick bile, Biliary sand |
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| Field | Gastroenterology |
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Biliary sludge refers to a viscous mixture of small particles derived from bile.[1][2] These sediments consist of cholesterol crystals, calcium salts, calcium bilirubinate, mucin, and other materials.[1][2][3]
Signs and symptoms[edit | edit source]
Complications[edit | edit source]
Biliary sludge may cause complications such as biliary colic, acute cholecystitis, acute cholangitis, and acute pancreatitis.[1][2]
Cause[edit | edit source]
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.[1][2] In many of these conditions, it is thought that the impairment in the contractility of the gallbladder leads to the formation of the sludge.[2]
Pathophysiology[edit | edit source]
The pathophysiology of biliary sludge formation is likely related to gallbladder dysmotility.[2] It is presumed that because the gallbladder is unable to effectively empty, the biliary sludge can start to accumulate.[2]
Diagnosis[edit | edit source]
Biliary sludge is typically diagnosed by CT scan or transabdominal ultrasonography.[1][2] Endoscopic ultrasonography is another more sensitive option. However, the gold standard is considered to be direct microscopy of aspirated gallbladder bile.[1][2] This method is much more sensitive, although it is less practical.[2]
Treatment[edit | edit source]
For patients without symptoms, no treatment is recommended. If patients become symptomatic and/or develop complications, cholecystectomy is indicated.[1] For those who are poor surgical candidates, endoscopic sphincterotomy may be performed to reduce the risk of developing pancreatitis.[1]
Prognosis[edit | edit source]
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.[1][2][3] If the biliary sludge has a cause (e.g. pregnancy), it oftentimes is resolved when the underlying cause is removed.[3]
Epidemiology[edit | edit source]
The prevalence of biliary sludge is low in the general population.[2] It has been reported that the prevalence ranges from 0-0.20% in men and 0.18-0.27% in women.[2] However, in patients with certain conditions, the prevalence may be higher.[2]
See also[edit | edit source]
References[edit | edit source]
External links[edit | edit source]
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