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Gallbladder Sludge

Dr Thng Yongxian

Hepatopancreatobiliary & General Surgeon
MBBS • MMed • MRCS (IRE) • FRCSED • FAMS

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What Is Gallbladder Sludge?

Gallbladder sludge, also known as biliary sludge, is a mixture of small particles derived from bile. These particles consist of cholesterol crystals, calcium salts, calcium bilirubinate, mucin, and other materials.

Causes and Risk Factors

Several factors can contribute to the formation of gallbladder sludge, including:

  • Prolonged fasting or rapid weight loss: Prolonged periods without eating may cause less frequent gallbladder contractions, reducing bile flow and leading to sludge accumulation. Similarly, rapid weight loss can increase cholesterol concentration in bile, contributing to sludge formation.
  • Pregnancy: Hormonal changes during pregnancy can affect gallbladder function, slowing the movement of bile and increasing the risk of sludge accumulation.
  • Certain medications: Some medications, such as ceftriaxone and octreotide, can alter the composition of bile or its flow, leading to sludge development.
  • Medical conditions: Conditions that affect bile flow, such as biliary tract infections, liver diseases, and certain genetic disorders, can increase the risk of gallbladder sludge.

Symptoms

In many cases, gallbladder sludge does not cause symptoms and is discovered incidentally during imaging tests for other conditions. However, when symptoms do occur, they may include:

  • Pain in the upper right abdomen, which may be steady or intermittent
  • Nausea and vomiting
  • Bloating
  • Digestive disturbances, such as indigestion or heartburn

Diagnostic Approaches

Diagnosis of gallbladder sludge typically involves imaging techniques that allow visualisation of the gallbladder and its contents:

Ultrasound

The most common diagnostic tool for detecting gallbladder sludge is ultrasound, which can visualise the presence of sludge as echoes within the gallbladder.

Magnetic Resonance Cholangiopancreatography (MRCP)

MRCP uses magnetic resonance imaging to produce detailed images of the bile ducts, gallbladder, and pancreas. It can help identify sludge and its impact on bile flow.

Endoscopic Ultrasound (EUS)

EUS involves using an endoscope equipped with an ultrasound device to obtain close-up gallbladder images. This method can be particularly useful in evaluating patients with suspected biliary disease when other imaging tests are inconclusive.

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Treatment Options

Non-Surgical Options

For individuals with gallbladder sludge that causes symptoms but does not necessitate immediate surgery, several non-surgical options can be considered:

  • Medications: Medication is ineffective in managing gallstones.
  • Dietary Changes: A diet low in fats and high in fibre can help manage symptoms associated with gallbladder sludge. Small, frequent meals may also promote regular gallbladder emptying.

Surgical Options

Surgical removal of the gallbladder, known as cholecystectomy, is considered when gallbladder sludge is associated with recurrent symptoms or complications. Cholecystectomy can be performed using:

  • Laparoscopic Cholecystectomy: This minimally invasive procedure involves small incisions through which surgical instruments and a camera are inserted to remove the gallbladder. It is the most common method due to its shorter recovery time and reduced pain compared to open surgery.
  • Open Cholecystectomy: In cases where laparoscopic surgery is not feasible or safe, an open cholecystectomy may be performed through a larger abdominal incision.

Potential Complications

Untreated gallbladder sludge can lead to complications, including:

Gallstones

Sludge can form stones, which may block the bile ducts, causing pain and increasing the risk of infection.

Pancreatitis

If gallstones or sludge block the pancreatic duct, it can cause inflammation of the pancreas.

Acute Cholecystitis

Inflammation of the gallbladder, often due to a blockage caused by sludge or gallstones, can lead to severe pain and infection.

Dr Thng Yongxian

Senior Consultant

HEPATOPANCREATOBILIARY & GENERAL SURGEON

MBBS (SG) • MMed (Surg) • MRCS (Ire) • FRCSEd (Gen) • FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery
  • National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.


Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.


Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

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Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

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