Biliary Sludge Is Formed by Modification of Hepatic Bile by the Gallbladder Mucosa

Magnetic resonance imaging of the fetal gallbladder and bile

“…Biliary sludge is formed by modification of hepatic bile by the gallbladder mucosa after prolonged stasis [21,22]. It is most commonly composed of cholesterol monohydrate crystals, calcium bilirubinate granules, or other calcium salts embedded in strands of gallbladder mucus [21,23].…”

Epidemiology of gallbladder stone disease

“…91,92 The basis is the gallbladder hypomotility that results from fasting with hepatic bile being altered in the gallbladder. 94 Gallbladder stasis from prolonged TPN and low-calorie diets with prolonged fasting are associated with sludge and stone formation but also as an aftermath of major abdominal surgery, 95,96 and solid organ and bone marrow transplantations. 97e99 The origin may be multifactorial, including critical illness, weight loss, TPN, drugs that impair gallbladder motility, and perhaps cyclosporine.…”

Effect of gallbladder hypomotility on cholesterol crystallization and growth in CCK-deficient mice

“…Clinical studies have observed that cholesterol monohydrate crystals could be detected in fresh duodenal bile samples [6–8]. Also, aggregated cholesterol monohydrate crystals embedded in mucin gel could often be observed by ultrasonography as biliary sludge, as confirmed by polarizing light microscopy in human gallbladder biles that are obtained after cholecystectomy [9–11]. It has been established that gallbladder stasis is an important prerequisite for gallstone formation because cholesterol is often nucleated into solid monohydrate crystals when cholesterol supersaturation in gallbladder bile reaches beyond a limit, as well as cholesterol crystal growth and aggregation are accelerated by pro-nucleating proteins such as mucins [12].…”