Abstract
Biliary sludge is a mixture of particulate matter which has precipitated from bile.
It generally consists of cholesterol monohydrate crystals, calcium bilirubinate or
other calcium salts. In a clinical setting, biliary sludge is almost always an ultrasonographic
diagnosis. Although it is less clinically applicable, direct microscopic examination
of gallbladder bile is far more sensitive than ultrasonography into sludge detection,
and has to be regarded as the diagnostic gold standard. The overall prevalence of
sludge in the general population is relatively low. However, several clinical conditions
are associated with a particularly high prevalence of biliary sludge, including pregnancy,
rapid weight loss, total parenteral nutrition, octreotide therapy, bone marrow or
solid organ transplantation. The clinical course of biliary sludge varies, and complete
resolution, a waxing and waning course, and progression to gallstones are all possible
outcomes. It may cause complications usually associated with gallstones, such as biliary
colic, acute cholecystitis, and acute pancreatitis. The main pathogenic mechanism
involved in sludge formation is probably gallbladder dismotility, and in selected
patients measures aimed to maintain adequate gallbladder contractions has been shown
to effectively prevent sludge development.
Keywords
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© 2003 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Inc. All rights reserved.
