Biliary sludge

Biliary sludge is a thick mixture of small particles that forms in bile, made up of cholesterol crystals, calcium salts, calcium bilirubinate, mucin and other material. It has been linked to pregnancy, rapid weight loss, total parenteral nutrition, drugs such as ceftriaxone and octreotide, organ transplantation and gastric surgery, and in many of these settings it is thought to arise because the gallbladder contracts poorly and does not empty well. It can cause biliary colic, acute cholecystitis, acute cholangitis and acute pancreatitis. It is usually found by CT or ultrasound, and direct microscopy of aspirated gallbladder bile is considered the gold standard. People without symptoms are not treated, while symptomatic cases may need gallbladder removal. The sludge may clear, come and go, or progress to gallstones, and reported prevalence in the general population is low.