biliary sludge

A mixture of particulate solids or sediment that have precipitated from bile.
It consists of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts.

It is usually detected on transabdominal ultrasonography.

It develops frequently during pregnancy, is usually asymptomatic, and spontaneously disappears after delivery.
Prolonged total parenteral nutrition is associated with the development with a very high concentration of mucin glycoprotein.
It often vanishes, particularly if the causative event disappears. Other cases wax and wane, and some go on to gallstones.

(Risk factors)
• Pregnancy.
• Rapid weight loss, particularly in the obese.
• Critical illness involving low or absent oral intake and the use of total parenteral nutrition.
• Following gastric surgery.
• Biliary stones with common bile duct obstruction.
• Certain drugs such as ceftriaxone and octreotide.
• Bone marrow or solid organ transplantation.

(Complications)
• biliary colic
• acute cholangitis
• acute pancreatitis

(Treatment)
• No therapy for asymptomatic patients with sludge or microlithiasis.
• Cholecystectomy for symptomatic patients or if complications arise.
• Biliary endoscopic sphincterotomy (cutting the sphincter muscle between the common bile duct and pancreatic duct) for the elderly or those at risk from the surgery. It can prevent recurrent episodes of pancreatitis.