Ultrasound images of Biliary stasis Fine echoes in the bile within the gallbladder are not uncommon on an ultrasound scan. This is commonly due to the inspissation of bile following prolonged starving, for example following surgery (Fig. A). These appearances disappear after a normal diet is resumed and the gallbladder has emptied and refilled.
It occurs when the solutes in the bile precipitate, often due to hypomotility of the gallbladder, and can commonly be seen following bone marrow transplantation and in patients who have undergone prolonged periods (4–6 weeks) of total parenteral nutrition. Prolonged biliary stasis may lead to inflammation and/or infection, particularly in postoperative patients and those on immunosuppression (Fig. B). Its clinical course varies from complete resolution to progression to gallstones. However, following the resumption of oral feeding, the gallbladder may contract and empty the sludge into the biliary tree causing biliary colic, acute pancreatitis and/or acute cholecystitis. For this reason, cholecystectomy may be considered in symptomatic patients with biliary sludge. The fine echoes may form a gravity-dependent layer and may clump together, forming ‘sludge balls’. To avoid misdiagnosing sludge balls as polyps, turn the patient to disperse the echoes or rescan after the patient has resumed a normal diet. Biliary stasis is associated with an increased risk of stone formation.
(A) Inspissated bile in the normal
gallbladder of a fasting patient. (B) Gravity-dependent
biliary sludge with a small stone.
Ultrasound images of gallbladder of a fasting patient, Ultrasound images hypomotility of the gallbladder, Ultrasound images acute cholecystitis, Ultrasound images acute pancreatitis, Ultrasound images Biliary stasis.

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