Bile is a greenish-yellow fluid that produced in the liver and stored in the gallbladder. It helps the body digest fats.
When small particles from bile remain in the gallbladder for too long, these particles can collect as gallbladder sludge.
- Gallbladder sludge does not always cause symptoms.
- Some risk factors make gallbladder sludge more likely.
- There is no need to treat gallbladder sludge if a person has no other symptoms.
What is gallbladder sludge?
The gallbladder is located underneath the liver, and produces bile.
Gallbladder sludge is a buildup of substances in the gallbladder. It is not a medical condition on its own but can lead to conditions, such as gallstones and pancreatitis. It can also go away on its own.
In most cases, a doctor discovers gallbladder sludge during an ultrasound of the gallbladder.
Gallbladder sludge is more frequently diagnosed in people with gallbladder and liver issues because people with these types of conditions are more likely to undergo diagnostic imaging tests.
Clinical significance of gallbladder sludge
Not all people with gallbladder sludge develop symptoms. When gallbladder sludge is caused by a risk factor, such as pregnancy, it usually goes away when the risk factor disappears.
For others, gallbladder sludge is linked to the following conditions:
- Acute pancreatitis: Acute pancreatitis is inflammation of the pancreas. One study found that 74 percent of people with pancreatitis without an apparent cause had gallbladder sludge.
- Gallstones: Some people who have gallbladder sludge eventually develop gallstones. Gallstones are collections of solid material such as cholesterol in the gallbladder. They can cause painful “gallbladder attacks.”
- Cholecystitis: This is swelling and inflammation of the gallbladder. It can cause bile to become trapped in the gallbladder, causing pain, vomiting, and bloating. Many factors, including infections of the gallbladder and gallbladder sludge, can cause cholecystitis.
- Blocked biliary ducts: The biliary ducts allow the gallbladder to drain. Sometimes gallbladder sludge accumulates in or near the ducts, blocking the ducts and causing gallbladder pain. This can cause infections, gallstones, and other gallbladder issues.
Gallbladder sludge follows one of 3 different courses. It may disappear entirely and never come back; it may go away then recur later, or it may persist, usually leading to the development of gallstones.
Causes of gallbladder sludge
Surgery on the stomach, as well as organ transplants, may cause gallbladder sludge.
The causes of gallbladder sludge include:
- alcohol abuse, which is linked to problems with both the gallbladder and liver
- previous history of gallbladder problems, especially gallstones or gallbladder sludge
- rapid weight loss, particularly of a lot of weight
- stomach surgeries
- organ transplants
- receiving only liquid nutrition through a line to a vein
- some medications
- serious illness, such as organ failure
- very restrictive diets
Pregnancy, which can stress the gallbladder, may also cause gallbladder sludge. Gallbladder sludge caused by pregnancy usually resolves when the pregnancy ends.
Many people with gallbladder sludge experience no symptoms. Even when gallbladder sludge causes gallstones, 80 percent of people will not have symptoms.
Some people only discover they have gallbladder sludge when they experience symptoms of a condition related to the sludge, such as acute pancreatitis.
When people do experience symptoms of gallbladder sludge, symptoms can include:
- abdominal pain
- vomiting and nausea
- pain in the upper abdomen, shoulder, or chest
- fatty stools, or stools that resemble tar or clay
These symptoms can also be signs of many other conditions, so it is essential to get an accurate diagnosis.
What are the treatment options?
It may not always be necessary to monitor the condition, since gallbladder sludge may resolve on its own. Other treatments include:
Medication and lifestyle remedies
A low-fat diet, avoiding rapid changes in weight, and avoiding alcohol may help to prevent gallbladder sludge from occuring.
In some cases, it may be possible to dissolve gallstones related to gallbladder sludge with medication.
Lifestyle remedies may prevent gallbladder sludge from recurring. Those strategies include:
- seeking treatment for alcohol abuse and abstaining from alcohol
- eating a low-fat diet
- avoiding rapid weight gain or weight loss
Treating underlying medical conditions can also help with gallbladder sludge since being in generally poor health can be a risk factor for this problem.
Those who have pain associated with gallbladder sludge, or who have gallstones or other symptoms, may need to have their gallbladders removed.
People can function well without a gallbladder, and people who are reasonably healthy are good candidates for gallbladder removal.
The surgery requires general anesthesia, meaning the person will be fully asleep during the operation.
Another option is endoscopic retrograde cholangiopancreatography (ERCP). ERCP is a nonsurgical procedure where a small flexible tube called an endoscope is inserted through the mouth and into the small intestine.
A small plastic catheter is passed through the endoscope and into the ampulla, which is an opening in the small intestine. The doctor uses an X-ray machine to help guide this catheter to remove gallbladder sludge within the bile ducts or remove a gallstone if it is trapped in the bile duct.
With both ERCP and gallbladder removal surgery, an individual will probably have to abstain from eating for several hours before the procedure. It may also be necessary to make dietary changes after the procedure.
When to see a doctor
People who have symptoms of gallbladder issues, such as upper abdominal pain, should always consult a doctor. In many cases, gallbladder problems appear as “attacks.”
These attacks may last several hours, disappear, and then come back later. Any intense abdominal pain with no obvious cause warrants a call to a doctor.
Most people with gallbladder sludge can lead normal, healthy lives. Many require no treatment at all. But an accurate diagnosis can rule out potentially dangerous problems, such as a pancreas infection or pancreatic cancer.
In most cases, a doctor will perform an ultrasound to see the gallbladder and check for gallbladder sludge.
In some cases, a doctor may need to remove a small amount of fluid from the gallbladder. The doctor uses a needle to remove some bile that will be analyzed under a microscope.
Gallbladder sludge is not an illness; it is a symptom of something else. It may go away on its own, but it may also provide clues to a more serious illness, or give rise to gallstones. Working with a skilled medical provider can rule out potential causes, identify the appropriate treatment, and help people lead long and healthy lives.