How Gallbladder Sludge Forms
Medically reviewed by Jay N. Yepuri, MDMedically reviewed by Jay N. Yepuri, MDGallbladder sludge, or biliary sludge, is a mixture of particles and bile that can build up in the gallbladder. The gallbladder is a small organ that stores and releases bile, a digestive fluid. It is on the right side of the body, under the liver.Gallbladder sludge may or may not cause symptoms. It may be found when looking for the cause of right-sided back or abdominal pain. It could also be seen when testing for another condition that doesn't involve the gallbladder (called an incidental finding).
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Does Gallbladder Sludge Always Cause Symptoms?Biliary sludge or gallbladder sludge does not always cause symptoms. There is not a lot of data on how many people with gallbladder sludge have symptoms. This is partly because it's not always thought of as a distinct condition that is diagnosed separately from gallbladder disease.Some of the general symptoms of a problem with the gallbladder, which may include gallbladder sludge, are:Abdominal bloatingFeverIntense, sudden pain in the upper right abdominal pain that spreads to the back or below the right shoulder bladeLoose stoolsNauseaPale or light stoolVomitingWithout PainOne study showed that 10% to 15% of people may have symptoms when they have gallbladder sludge. Most people don't have any gallbladder pain and may not know there is any biliary sludge. Symptoms may come and go or stop completely.Some people may have an inflamed gallbladder or later develop gallstones. Gallstones are pebble-like lumps of cholesterol or pigments that form in the gallbladder.With PainWhen abdominal pain is present, there is a 50% chance that the sludge will clear up on its own. In 20% of people, the sludge may be present but cause no symptoms.About 10% to 15% of people with abdominal pain who have gallbladder sludge go on to have symptoms of gallbladder disease. The other 5% to 15% will experience progressive disease and the formation of gallstones.Gallbladder Sludge on Ultrasound Gallbladder sludge may be seen during an ultrasound. Usually, an ultrasound would be used when there are symptoms, and it's suspected that the gallbladder is the cause.An ultrasound uses sound waves to see the structures and organs inside the body. When there's a reason to look at the gallbladder, the test used is called a transabdominal ultrasound. Gallbladder sludge bounces the sound waves back, so it is seen during this test.If sludge is seen but there doesn't appear to be any gallstones, another test may be done. Some gallbladder sludge may be removed during an endoscopic retrograde cholangiopancreatography (ERCP) and examined in a lab to determine the contents of the sludge, such as small solid particles or crystals.Another test that might be used is endoscopic ultrasonography (EUS). An EUS combines endoscopy and ultrasound. A thin tube is passed into the mouth and down through the digestive tract. Special tools and a camera on the end can be used to look at the structures in the body and obtain some fluid from inside the gallbladder.Formation From BileBile is a substance needed by the body to digest fats eaten in food. Bile is produced in the liver and transported to the gallbladder, where it is stored.When bile stays in the gallbladder for longer than it should, it can become stagnant. It begins to form particles that turn into sludge. The contents of gallbladder sludge can vary based on the cause.Sludge in the gallbladder could contain:Calcium bilirubinate granulesCalcium salts held by strands of mucin gelCholesterol crystalsMineralsProtein-lipid complexesSoluble mucin proteinsUndefined residuesSome of the causes and risk factors for gallbladder sludge are similar to those of gallstones, such as:Excess bilirubin (formed from the breakdown of red blood cells)High cholesterolLack of bile salts (formed in the liver to help break down fats)There are several reasons why people may be more likely to develop gallbladder disease or sludge.Nonhereditary reasons for the development of gallbladder problems include:Certain acute and chronic illnessesCertain medicationsOrgan transplantsParenteral nutrition (nutrition given through a vein)PregnancyWeight lossSome of the acute and chronic conditions that can cause gallbladder problems are:Cirrhosis, in which liver scarring affects its functionDiabetes or insulin resistance, which affect blood sugarCrohn’s disease and other digestive conditions that affect the normal absorption of nutrientsHemolytic anemias that cause the breakdown of red blood cellsHigh triglyceride levelsInfections in the bile ductsLow levels of high-density lipoprotein (HDL) cholesterolMetabolic syndrome, which is characterized by hypertension (high blood pressure), high blood sugar, dyslipidemia (abnormal levels of cholesterol and fat in the blood), and excess abdominal fatPeople of certain ages, sexes, and ethnicities are more likely to be diagnosed with gallbladder disease. These groups include:Mexican AmericansNative AmericansOlder peoplePeople with a family history of gallstonesWomen
A Note on Gender and Sex TerminologyVerywell Health acknowledges that sex and gender are related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
Some people may also have a genetic factor that makes them more likely to have gallbladder disease. Several genes, called lithogenic (LITH) genes, may make a person more likely to develop gallbladder stones or disease. The LITH genes affect the creation and transport of cholesterol and bile acids.Certain variants of LITH genes may make a person more likely to have gallstones that have symptoms. It's estimated that 25 to 30% of symptomatic gallstones may be associated with variants in LITH genes.TreatmentIf sludge is seen or suspected, a sample of it may need to be obtained. This could be done during an ERCP or an EUS, especially when there are symptoms in the upper digestive system. A healthcare provider will not want to use too many invasive tests unless there is a compelling reason.For some people, a watch-and-wait approach (a period of observation in which no treatment is given) might be used for gallbladder sludge. This is especially true if there aren't any symptoms, but the sludge was found incidentally (while looking for a different issue).People who have documented gallbladder sludge may be candidates for treatment with Actigall (ursodeoxycholic acid). This treatment is a medication that can help with sludge, but it isn't recommended if someone has actual gallstones.Removal of the gallbladder (cholecystectomy) may be recommended, especially for people who are having symptoms. This treatment would be curative because without the gallbladder, sludge can no longer form in it.There is little evidence that alternative and complementary methods can help clear the gallbladder of sludge or prevent gallstones.What to EatTo manage gallbladder sludge, your healthcare provider may recommend some changes to your diet. In general, a healthful diet that prioritizes fruit and vegetables and includes less fat and sugar will be recommended.These tips may be helpful when considering a diet to support gallbladder health include:Adding healthy fats, such as fish oil and olive oil, to the dietAvoiding or eating fewer refined carbohydratesAvoiding unhealthy fats, such as those found in desserts and fried foodsEating fewer foods that contain sugarPrioritizing high-fiber foods that include fruits, vegetables, beans, peas, and whole grainsIt's also worth noting that rapid weight loss may also be associated with a risk of gallbladder disease. Having weight loss surgery or following a diet that is very low in calories may put people at risk for gallstones. Therefore, working with a healthcare provider on changing your diet is important, especially when you are losing weight quickly.Some observational studies show that drinking coffee may be associated with a lower incidence of gallbladder problems.Monitoring Related Complications and Conditions Gallbladder sludge may progress to gallbladder disease or gallstones. A healthcare provider can assess whether monitoring or treatment is needed.When sludge formation is due to an event such as pregnancy or rapid weight loss, it may resolve when the event is over, and symptoms may resolve naturally.However, in some cases, sludge is associated with complications, such as the formation of gallstones. There's also a potential to develop biliary colic. This is when a bile duct becomes obstructed, causing pain and other symptoms.When gallstones form, they can lead to a host of other problems. Gallstones can be removed with an ERCP, broken up into smaller pieces, or the gallbladder can be surgically removed. Gallstones may cause pain and complications without treatment.However, much is still not known about gallbladder sludge and how it may affect overall health. Some of the data on this condition are from people who are living with other conditions or even gallstones, so it is challenging to know how it will affect people without complicated medical histories.
Abdominal or Radiating PainGallbladder pain can be acute (sudden), or it can come and go over a few days. It may also go away only to return after eating a fatty meal. People diagnosed with a gallbladder condition will want to stick to a diet that doesn't cause symptoms. With or without an established diagnosis, New or worsening pain is a reason to see a healthcare provider as soon as possible.
SummaryGallbladder sludge can occur with or without symptoms. Most people will not know that they have gallbladder sludge or have any symptoms. Sludge in the gallbladder could lead to developing stones in the gallbladder.There is usually no treatment prescribed when sludge is found without any other risks, but gallbladder removal may be used if there is a progression to complications. Read the original article on Verywell Health.
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