Gallbladder sludge is a collection of cholesterol, calcium, bilirubin, and other compounds that build up in the gallbladder. It may indicate an underlying condition. Symptoms may include nausea, vomiting, and abdominal pain.

Gallbladder sludge or biliary sludge occurs when bile stays in the gallbladder for too long. Bile is a greenish-yellow fluid that helps the body digest fats. The liver produces bile and the gallbladder stores it.

When small particles from bile remain in the gallbladder for too long, these particles can collect as gallbladder sludge.

This article explains everything about gallbladder sludge, including the causes, symptoms, and treatment options.

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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 and may go away and come back repeatedly.

In most cases, a doctor discovers gallbladder sludge during an ultrasound of the gallbladder.

People with gallbladder and liver issues may be more likely to get a gallbladder sludge diagnosis because they are more likely to undergo diagnostic gallbladder imaging tests.

Most people with gallbladder sludge have no symptoms. When gallbladder sludge occurs due to a risk factor, such as pregnancy, it usually disappears when the cause disappears.

In other cases, gallbladder sludge may link to a health condition, such as:

  • Acute pancreatitis: Acute pancreatitis is inflammation of the pancreas. A 2020 systematic review and meta-analysis suggested biliary sludge was one of the most common causes of acute pancreatitis without an apparent cause.
  • Gallstones: Research suggests up to 20% of people with 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 inflammation of the gallbladder that can cause bile to become trapped in the gallbladder, causing pain, vomiting, and bloating. Factors such as gallbladder infections and gallbladder sludge can cause cholecystitis.
  • Blocked biliary ducts: The biliary ducts allow the gallbladder to drain. Gallbladder sludge can accumulate in or near the ducts, blocking the ducts and causing gallbladder pain. This can cause infections, gallstones, and other gallbladder issues.

Gallbladder sludge can follow one of three different courses. It may disappear entirely and never come back, go away and recur later, or persist, usually leading to the development of gallstones.

Factors or conditions that can cause or increase the risk of gallbladder sludge include:

Most people with gallbladder sludge experience no symptoms. Even when gallbladder sludge causes gallstones, around 80% of people will not have symptoms, and those who do may not experience symptoms until up to 20 years after diagnosis.

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:

These symptoms can also be signs of many other conditions, so it is essential to get an accurate diagnosis.

It may not always be necessary to monitor gallbladder sludge since it may resolve on its own. When treatment is necessary, it may include the following:

Medication and lifestyle remedies

Lifestyle remedies and certain medications can help treat risk factors, which may help prevent gallbladder sludge from recurring. Strategies include:

  • limiting alcohol intake
  • eating a balanced diet
  • avoiding rapid weight gain or weight loss

People can speak with a healthcare professional about the best lifestyle changes to prevent and treat gallbladder sludge.

Surgical options

People who have pain due to gallbladder sludge or who have gallstones or other symptoms may need to have their gallbladders removed. This surgery is called a cholecystectomy.

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.

People with symptoms of gallbladder issues, such as upper abdominal pain, should always consult a doctor. In some cases, gallbladder sludge symptoms may come and go.

Any intense abdominal pain with no apparent cause warrants a call to a doctor.

Most people with gallbladder sludge can lead typical lives. Many require no treatment at all. However, an accurate diagnosis can rule out potentially dangerous problems, such as a pancreas infection or pancreatic cancer.

During a diagnosis, a doctor may 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 for analysis under a microscope.

Gallbladder sludge is not an illness, but can indicate or lead to certain conditions. 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 healthcare professional can rule out potential causes, identify the appropriate treatment, and help people lead long and healthy lives.

Anyone with symptoms such as severe abdominal pain should speak with a doctor as soon as possible to identify the underlying cause.