Gallbladder sludge

Biliary sludge refers to a viscous mixture of small particles derived from bile.

Sediments include: consist of cholesterol crystals, calcium salts, calcium bilirubinate, mucin, and other materials.

The prevalence is low: ranges from 0-0.20% in men and 0.18-0.27% in women.

Biliary sludge may cause complications such as biliary colic, acute cholecystitis, acute cholangitis, and acute pancreatitis.

It is associated with pregnancy, rapid weight loss, total parenteral nutrition, drugs such as ceftriaxone and octreotide, solid organ transplantation, and gastric surgery.

It is proposed the impairment in the contractility of the gallbladder leads to the formation of the sludge,and is likely related to gallbladder dysmotility,when the gallbladder is unable to effectively empty, the biliary sludge can start to accumulate.

Biliary sludge is typically diagnosed by CT scan or transabdominal ultrasonography.

Endoscopic ultrasonography is another more sensitive option. 

For patients without symptoms, no treatment is recommended. 

If patients become symptomatic and/or develop complications, cholecystectomy is indicated.

In poor surgical candidates, endoscopic sphincterotomy may be performed to reduce the risk of developing pancreatitis.

The clinical course of biliary sludge: 1) resolve completely, (2) wax and wane, or (3) progress to gallstones.

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