When the gallbladder doesn’t empty completely, cholesterol monohydrate crystals, calcium bilirubinate, or other calcium salts in the bile can thicken, forming sludge. Particles of those calcium salts “can become like rock candy,” explains Jeffrey L. Ponsky, MD, chairman of the department of surgery at the University Hospitals Case Medical Center in Cleveland. “If you look under a microscope, and you see little sand-like particles — that’s sludge.” Gallbladder Sludge and Gallstones: What’s the Connection? It’s possible that you have sludge in your gallbladder right now, and you’ll never know. In some people, sludge comes and goes, and never causes a problem. In other cases, sludge can thicken further, and can lead to the formation of the rock-like objects called gallstones. While the presence of sludge in the gallbladder is a step in the process of forming gallstones, having sludge in the gallbladder does not necessarily mean gallstones are inevitable. Sludge — and even tiny stones — may pass through the bile duct and cause typical gallbladder pain symptoms, or they may cause no symptoms at all. “The incidental finding of sludge on an X-ray [done for another reason] does not indicate the need for surgery,” Dr. Ponsky says. If a patient finds out incidentally that he has sludge in the gallbladder, as Ponsky says happens occasionally, treatment may be unnecessary. However, the patient should be made aware of the potential risks of having sludge in the gallbladder, which include acute inflammation of the gallbladder if the sludge combines with mucus to block the bile duct. Such an occurrence is relatively unusual, Ponsky notes. Does Gallbladder Sludge Require Surgery? In most cases, sludge in the gallbladder doesn’t require any treatment. As long as there are no symptoms, no medical intervention is necessary. “I tell my patients, just live your life,” Ponsky says. On the other hand, when a patient complains about pain around the gallbladder, a physician may order an ultrasound or X-ray of the abdomen to determine if sludge or gallstones are present in the gallbladder. If sludge or gallstones in the gallbladder appears to be the cause of the pain, a doctor probably will recommend cholecystectomy, the surgical removal of the gallbladder. Gallbladder Sludge: Who Is at Risk? Sludge in the gallbladder is not typical in the general population; however, women are at greater risk than men, and Native Americans seem to have more gallbladder problems than do other ethnic groups. Diabetes and pregnancy are other factors that can increase a person’s risk of developing sludge in the gallbladder. Critically ill patients, overweight people who lose weight rapidly, and those who have had an organ transplant are also at a greater risk of experiencing gallbladder problems. If you’re at risk or worried about your gallbladder health, you may be wondering about:
Abdominal pain. Pain in the upper abdomen, particularly on the right side and experienced shortly after a meal, may be a symptom of gallbladder problems.Chest pain. Although pain related to a gallbladder problem is most typically reported in the abdomen, substernal (chest) pain, as well as right shoulder pain, may be related to the gallbladder.Nausea. Nausea — and vomiting — can be symptoms of a gallbladder problem.Changes in bowel movement. Stools with a clay-like appearance may also indicate a gallbladder problem.
Although surgical removal of the gallbladder is often recommended for the treatment of gallstones, some medications can also be used to dissolve stones or reduce the formation of sludge. As always, it’s wise to talk with your doctor about all of your treatment options.
