Gallbladder Sludge – Causes, Symptoms and Treatment

The digestion of food within the alimentary canal is aided by a variety of enzymes and other substances secreted by organs such as the pancreas, liver, and gallbladder. These organs are not part of the main alimentary canal, but are attached to it. The gallbladder is a pear-shaped organ that is located in the upper right quadrant of the abdominal cavity. This tiny organ is located behind the liver.

The liver synthesizes a digestive fluid known as the bile, which helps in the digestion of fatty foods. The bile synthesized in the liver is passed on to the gallbladder via the common hepatic duct. The gallbladder stores and concentrates the bile before releasing it into the first part of the small intestine (called the duodenum) via the common bile duct.

Therefore, problems associated with the gallbladder (such as formation of bile stones) can affect the flow of bile into the small intestine, resulting in incomplete digestion of foods.

What is gallbladder sludge?

The most well known condition affecting the gallbladder is the formation of gallstones. The gallstones are formed by deposits of cholesterol in the bile. In most cases, gallstones are tiny and do not cause any symptoms. They get passed out into the duodenum along with the bile. In some cases, the gallstones become large enough to block the flow of bile through the bile ducts, leading to pain and other symptoms.

Gallbladder sludge (also known as biliary sludge) is another condition that affects the consistency of bile in the gallbladder. Biliary sludge refers to an abnormal gelatinous consistency of bile. It is thought that biliary sludge could be a precursor to the formation of gallstones. However, biliary sludge dissolves and passes out of the gallbladder in most cases, without resulting in the formation of gallstones.

Sludge vs Stones

Biliary sludge is composed of mucus, concentrated cholesterol (in the form of crystals), and calcium bilirubinate granules that can appear as a sediment. The mucus in the biliary sludge provides a scaffold for the buildup of cholesterol stones. However, biliary sludge should not be taken as a precursor of gallstone formation, unless the condition is chronic.

When biliary sludge is present for a long time, the conditions in the gallbladder may be suitable for the formation of cholesterol stones. In fact, the presence of small gallstones may be missed when the gallbladder contains biliary sludge. The presence of biliary sludge usually gets detected during an ultrasound examination.

Causes of Gallbladder Sludge

The gallbladder is a storage chamber for the bile produced by the liver. During its storage in the gallbladder, the bile is concentrated via the removal of water. When the concentration of bile increases beyond a threshold, components of the bile may precipitate out and form sediments or stones.

Cholesterol and calcium bilirubinate are the most common components of such sediments and gallstones. The mucus present in the lining of the gallbladder acts as a scaffold to facilitate the formation of gallstones from the sediments that form during the concentration of bile. In most cases, the resulting biliary sludge is expelled from the gallbladder before it gets too concentrated and results in the formation of large gallstones.

The chance of formation of gallbladder sludge increases under certain conditions. Chronic fasting, dieting, and pregnancy are some of the conditions where the likelihood of biliary sludge formation is high. Parenteral nutrition, in which a person is provided with nutrients through an intravenous route, also increases the likelihood of biliary sludge formation.

The lack of food in the gut prevents the flow of bile from the gallbladder into the duodenum. Since the production of bile in the liver is a continuous process, more bile finds its way into the gallbladder. To store the increasing volume of bile that it receives, the gallbladder concentrates the bile further. Consequently, the conditions in the gallbladder become increasingly conducive to the formation of biliary sludge and gallstones.

Signs and Symptoms

The presence of biliary sludge in the gallbladder does not cause any symptoms on its own. The symptoms that may occur depend on other factors such as the formation of stones in the gallbladder or the bile ducts. Formation of gallstones within the gallbladder may be promoted by the presence of biliary sludge.

In such cases, the symptoms produced are typically the symptoms caused by gallstones, rather than the biliary sludge. Gallbladder sludge is more likely to cause formation of stones in the bile duct (called primary bile duct stones) than in the gallbladder itself. Primary bile duct stones are also associated with parasitic or bacterial infections (such as the liver fluke).

Read more on signs of gallstones.

The presence of gallstones can cause inflammation of the gallbladder (technically referred to as calculous cholecystitis). Inflammation of gallbladder can also occur in the absence of gallstones. Such a condition is referred to as acalculous cholecystitis. Biliary sludge is a potential cause of acalculous cholecystitis as well. Unlike calculous cholecystitis, the onset of acalculous cholecystitis is more gradual.

It is important to mention that biliary sludge may or may not be the cause of gallstone formation. Gallstone pain is more likely to occur due to the presence of small gallstones, which can lead to cholangitis, cholecystitis, and pancreatitis. In fact, small gallstones may not be diagnosed during ultrasound due to the presence of biliary sludge. In such false-negative cases, the cause of gallstone pain may be misattributed to the presence of biliary sludge.

Treatment of Gallbladder Sludge

In most cases, gallbladder sludge is cleared normally through the passage of bile. Bile secretion into the duodenum increases in response to a meal. Therefore, increased frequency of meals results in a constant removal of biliary sludge from the gallbladder. Dietary changes, such as consuming more low-sugar and low-fat meals can also reduce the chances of gallstone formation. No treatment is usually required in most cases.

In case of recurrent gallstone formation and bothersome symptoms, one should consult a doctor for appropriate treatment. The underlying cause of persistent biliary sludge formation (or gallstone formation) needs to be diagnosed before an appropriate treatment can be determined. Surgical removal of the gallbladder (technically known as cholecystectomy) may be an option if obstruction of bile duct due to gallstones is causing serious complications. No “natural therapy” or herbs should be used for treatment without consulting a doctor.