The gallbladder is a small pear-shaped organ under the liver. It collects, stores, and releases bile into the small intestine. Bile contains cholesterol, fluids, and fats and helps the GI tract absorb nutrients and fat-soluble vitamins.
Gallbladder sludge or biliary sludge forms when bile sits in the gallbladder for an extended period.
Cholesterol is a component of the bile. Too much cholesterol in the body oversaturates the fluid, however, and solid particles of cholesterol, bilirubin, and calcium accumulate. Sometimes, this build-up forms gallstones, but not always. If it accumulates but doesn't form stones, it is called gallbladder sludge.
The causes of gallbladder sludge are not completely understood. It is associated with many conditions. These include pregnancy, rapid weight loss in obese people, gastric surgery, the use of total parenteral or IV nutrition, and low or no oral intake. Gallbladder sludge is also associated with certain drugs and bone marrow or solid organ transplants.
Gallbladder sludge has a varied progression that depends, to some extent, on the cause. If it is the result of pregnancy or another identifiable cause, then it usually disappears when the cause resolves. Sometimes, it comes and goes, but gallbladder sludge can also evolve into gallstones or pass into the ducts and cause a blockage.
Cholecystitis or inflammation of the gall bladder is one complication of gallbladder sludge. If the duct leading out of the gallbladder is blocked or narrowed by sludge, bile backs up and causes inflammation. When untreated, cholecystitis can lead to serious complications, and the treatment is usually gallbladder removal. Symptoms include pain in the upper abdomen that may spread to the shoulder or back, vomiting, nausea, and fever.
Gallbladder sludge can also lead to biliary colic, pain from a blocked duct that causes the gallbladder to swell. People usually feel this pain under the ribs on the right side. It tends to increase over the first hour, remain constant for up to 12 hours, then slowly recede over a 30 to 90-minute period.
Biliary colic usually resolves on its own, but between 20 and 40 percent of people experience recurrences annually.
Another complication of gallbladder sludge is acute pancreatitis. This form is sometimes called gallbladder pancreatitis and occurs when gallbladder sludge blocks the opening to the small intestine, causing fluid to back up into the bile duct and pancreas. Acute pancreatitis can last for days. Symptoms include vomiting, nausea, fever, rapid heart rate, and upper abdominal pain that worsens after eating.
Generally, patients are only evaluated for gallbladder sludge or stones when they develop symptoms. Both issues are often found when imaging is ordered for other reasons. Management for these conditions is similar, and doctors should follow up with asymptomatic patients in case symptoms develop.
Doctors may choose cholecystectomy or removal of the gallbladder when symptoms from gallbladder sludge are serious.
If the patient is unable to undergo surgery, some non-surgical interventions can help, including oral medications to dissolve gallbladder sludge. A percutaneous cholecystostomy with drainage involves inserting a tube through a small incision into the gallbladder to drain excess bile.
These non-surgical interventions have not been extensively studied for patients with gallbladder sludge and have limited effectiveness for gallstones.
The causes of gallbladder sludge are not well understood, but as it can be a precursor to gallstones, eating a healthy diet and getting regular exercise can help.
Choose foods that are high in fiber and healthy fats, like olive and fish oil. Avoid refined carbohydrates, sugar, unhealthy fats like fried foods, and rich desserts. It is important to lose extra pounds to prevent the condition, but losing weight too quickly can cause gallbladder sludge and stones. Consult a physician before starting a low-calorie diet.
Research on gallbladder sludge is limited. One study showed that patients have a significantly higher risk of gallbladder-related problems within five years. Specifically, of the study participants with gallbladder sludge, 15.6 percent experienced acute cholecystitis, 15.5 percent experienced an inflamed bile duct, and 18.4 percent experienced acute pancreatitis. For those who did not have gallbladder sludge, the incidence was reduced by two-thirds or more in each instance.
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