What is sludge and where does it come from?
Bile consists of bile acids, cholesterol and phospholipids, which are normally in stable equilibrium. If bile stagnates in the bladder or there is too much cholesterol in it, microcrystals begin to fall out. Together with mucus they form a thick suspension. The main factor of stagnation is rare meals: the bladder contracts in response to food, and if a person does not eat for a long time, the bile just sits. This is why sludge often appears during strict diets, prolonged fasting and very rapid weight loss.
- Imbalance of bile components
- Stagnation with infrequent meals
- Rapid weight loss and strict diets
- Pregnancy and hormonal changes
- Taking certain medications
- Vein nutrition and serious illnesses
Symptoms
Most often, sludge is asymptomatic and becomes an incidental finding on ultrasound. Some people experience heaviness and dull discomfort in the right hypochondrium after fatty foods, bitterness in the mouth, nausea, bloating and unstable stools. These complaints are nonspecific and occur in many conditions, so they must be associated with sludge with caution. Paroxysmal severe pain in the right hypochondrium, radiating to the back and right shoulder, already indicates biliary colic and requires examination by a doctor.
- Most often there are no complaints
- Heaviness in the right hypochondrium after fatty
- Bitterness in the mouth and nausea
- Bloating and loose stools
- Biliary colic when a clot passes
- Complaints are often nonspecific
How can it be dangerous?
For most people, sludge does not lead to complications, and for a significant proportion it disappears on its own, especially if the cause is eliminated: pregnancy ends, the diet is normalized. However, if it exists for a long time, it can become the basis for the formation of stones. In addition, small clots and microliths can enter the biliary tract and cause biliary colic, inflammation of the gallbladder, and if the duct is blocked, obstructive jaundice and acute pancreatitis. That is why sludge found on ultrasound is not ignored, but is assessed along with complaints and risk factors.
- May disappear on its own
- Can be used as a base for stones
- Possible biliary colic
- Inflammation of the gallbladder
- Blocked duct and jaundice
- Biliary pancreatitis
Diagnostics
The main method is ultrasound of the abdominal cavity, which is performed on an empty stomach: sludge is visible as a moving echogenic suspension without an acoustic shadow, unlike a stone. Sometimes the sediment forms a level or lump-like mass, so it is important to evaluate its displacement when turning the patient. Additionally, the doctor prescribes liver tests, bilirubin, amylase and lipase to rule out inflammation and disruption of the outflow of bile. If the picture is questionable, MR cholangiography and endoscopic ultrasound are used, which are prescribed by a gastroenterologist.
- Ultrasound of the abdominal cavity on an empty stomach
- Estimation of suspension displacement
- Liver tests ALT and AST, bilirubin
- Amylase and lipase
- MR cholangiography if in doubt
- Repeat ultrasound in a few months
Treatment and nutrition
If there are no complaints, it is often enough to eliminate the cause and repeat the ultrasound after a few months. The basis is regular meals four to five times a day without long breaks, avoiding fasting and losing weight faster than a reasonable pace, limiting fatty and fried foods, sufficient fluid and fiber intake, and physical activity. For complaints and persistent sludge, the doctor may prescribe ursodeoxycholic acid medications in a course. So-called liver cleanses, oil tubes and herbal laxatives are dangerous: they can cause clot release and colic.
- Eat regularly, 4–5 times a day
- Don't starve and lose weight gradually
- Limit fatty and fried foods
- Enough fiber and fluid
- Regular physical activity
- Ursodeoxycholic acid preparations as prescribed by a doctor
- Do not perform liver tubing or cleansing