biliary sludge
{{Infobox medical condition (new)
| name = Biliary sludge
| synonyms = Gallbladder sludge, Microcrystalline disease, Biliary sediment, Thick bile, Biliary sand, biliary gravel
| image = Ultrasonography of sludge and gallstones, annotated.jpg
| caption = Abdominal ultrasonography showing biliary sludge and gallstones
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| field = Gastroenterology
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Biliary sludge refers to a viscous mixture of small particles derived from bile.{{Cite journal | pmid = 11276386| year = 2001| last1 = 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| s2cid = 46592201}}{{Cite journal | pmid = 12974509| year = 2003| last1 = 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}} These sediments consist of cholesterol crystals, calcium salts, calcium bilirubinate, mucin, and other materials.{{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}}
Signs and symptoms
=Complications=
Biliary sludge may cause complications such as biliary colic, acute cholecystitis, acute cholangitis, and acute pancreatitis.
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. In many of these conditions, it is thought that the impairment in the contractility of the gallbladder leads to the formation of the sludge.
Pathophysiology
The pathophysiology of biliary sludge formation is likely related to gallbladder dysmotility. It is presumed that because the gallbladder is unable to effectively empty, the biliary sludge can start to accumulate.
Diagnosis
File:Gallbladder hepatization.jpg 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. Endoscopic ultrasonography is another more sensitive option. However, the gold standard is considered to be direct microscopy of aspirated gallbladder bile. This method is much more sensitive, although it is less practical.
Treatment
For patients without symptoms, no treatment is recommended. If patients become symptomatic and/or develop complications, cholecystectomy is indicated. For those who are poor surgical candidates, endoscopic sphincterotomy may be performed to reduce the risk of developing pancreatitis.
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. If the biliary sludge has a cause (e.g. pregnancy), it oftentimes is resolved when the underlying cause is removed.
Epidemiology
See also
References
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External links
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| ICD10 = {{ICD10|K|83|9|k|80}}
| ICD9 = {{ICD9|576.8}}
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{{Use dmy dates|date=April 2017}}
Category:Disorders of gallbladder, biliary tract and pancreas