The prevalence of biliary sludge is low in the general population.

A recent Italian study showed that during pregnancy or the puerperium 41% of women develop biliary sludge.

The pathophysiology of biliary sludge formation is likely related to gallbladder dysmotility.

Biliary sludge refers to a viscous mixture of small particles derived from bile.

Biliary sludge is typically diagnosed by CT scan, transabdominal ultrasonography.

It is presumed that because the gallbladder is unable to effectively empty, the biliary sludge can start to accumulate.

If the biliary sludge has a cause (e.g. pregnancy), it oftentimes is resolved when the underlying cause is removed.

Analysis of biliary sludge obtained through endoscopic retrograde cholangiopancreatography (ERCP)

Ceftriaxone may precipitate in bile, causing biliary sludge, biliary pseudolithiasis, and gallstones, especially in children.

Biliary sludge contains cholesterol crystals, calcium bilirubinate granules, and very high concentrations of mucin glycoprotein, a putative nucleating agent.

Biliary sludge may cause complications such as biliary colic, acute cholecystitis, acute cholangitis, and acute pancreatitis.

Biliary sludge has been associated with pregnancy, rapid weight loss, total parenteral nutrition, drugs such as ceftriaxone and octreotide, solid organ transplantation, and gastric surgery.

Six percent of patients on TPN longer than 3 weeks and 100% of patients on TPN longer than 13 weeks develop biliary sludge.

Wilkinson LS, Levine T, Chadwick SJD. (1996) Biliary sludge - can ultrasonography reliably detect the presence of crystals in bile?

Pregnancy is often associated with two definite gall bladder abnormalities - namely, reduced gallbadder contractility which is believed to be due to raised progesterone concentrations, and the development of biliary sludge.

Gallbladder sludge disappears after 4 weeks of normal oral diet.

The only side effects which did not show dose response in the clinical trials were hyperglycemia, cholelithiasis and formation of gallbladder sludge.

These tend to be GI side effects, hyperglycemia, cholelithiasis and formation of gallbladder sludge, and bradycardia. In the majority of patients these side effects are tolerable.