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Biliary sludge

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Biliary sludge

Biliary sludge
Classification and external resources
ICD-10 K83.9
ICD-9-CM 576.8
Alternative names Biliary sludge

Gallbladder sludge
Microcrystalline disease
Biliary sediment
Thick bile
Biliary sand

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]

Contents

  • Pathophysiology 1
  • Cause 2
  • Epidemiology 3
  • Diagnosis 4
  • Prognosis 5
  • Treatment 6
  • Complications 7
  • See also 8
  • References 9

Pathophysiology

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]

Cause

Biliary sludge has been associated with

  1. ^ a b c d e f g h i Shaffer, E. A. (2001). "Gallbladder sludge: What is its clinical significance?". Current gastroenterology reports 3 (2): 166–73.  
  2. ^ a b c d e f g h i j k l m n Pazzi, P; Gamberini, S; Buldrini, P; Gullini, S (2003). "Biliary sludge: The sluggish gallbladder". Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 35 Suppl 3: S39–45.  
  3. ^ a b c "Gallbladder and Bile Duct Disorders". Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Retrieved 15 January 2015. 

References

See also

Biliary sludge may cause complications such as biliary colic, acute cholecystitis, acute cholangitis, and acute pancreatitis.[1][2]

Complications

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]

Treatment

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]

Prognosis

Biliary sludge is typically diagnosed by 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]

Diagnosis

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]

Epidemiology

[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][1]

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