Biliary sludging

Cholelithiasis, biliary sludge, acute and chronic cholecystitis, and cholestasis (can be progressive and life-threatening)... 

Biliary sludge A deposit of tiny stones or crystals made up of cholesterol, calcium bilirubinate, and other calcium salts. The cholesterol and calcium bilirubinate crystals in biliary sludge can lead to gallstone formation. 

Adverse effects of octreotide therapy include nausea, vomiting, abdominal cramps, flatulence, and steatorrhea with bulky bowel movements. Biliary sludge and gallstones may occur after 6 months of use in 20-30% of patients. However, the yearly incidence of symptomatic gallstones is about 1%. Cardiac effects include sinus bradycardia (25%) and conduction disturbances (10%). Pain at the site of injection is common, especially with the long-acting octreotide suspension. Vitamin B12 deficiency may occur with long-term use of octreotide. 

Adverse effects of therapy include nausea with or without vomiting, abdominal cramps, flatulence, and steatorrhea with bulky bowel movements. Biliary sludge and gallstones may occur after 6... 

Gastrointestinal Pseudomembranous colitis, biliary sludge, jaundice Respiratory Bronchospasm, allergic pneumonitis... 

Biliary sludging has been documented in children receiving ceftriaxone. The formation of biliary sludge has been reported to lead to biliary obstruction, cholecystitis, choledocholithiasis and psendolithiasis. Most cases are asymptomatic, transient, reversible, and nsnally only necessitate conservative management. However, greater care is required in patients with pre-existing liver disease, and it is advised that abdominal ultrasound scans are performed when ceftriaxone is initiated [2]. It would seem sensible to consider alternative antibiotic therapy in these types of patient. 

Consider Gl ulceration, sedation, coagulopathy, platelet effects, effects on fluid balance, effect on electrolytes, biliary sludging, renal impairment, constipation Oesopbagifis/oesopbageai ulceration if taken before bed or with inadequate fluids... 

Ceftriaxone does not seem to predispose to subsequent gallbladder stone formation, as assessed 6 and 12 months later (107). The pathogenesis relates to ceftriaxone s high rate of bihary excretion and the subsequent formation of calcium-containing precipitates (108). Thus, apart from the risk factors mentioned above, the risk of biliary sludge... 

Shiftman ML, Keith FB, Moore EW. Pathogenesis of ceftriaxone-associated biliary sludge. In vitro studies of calcium-ceftriaxone binding and solubility. Gastroenterology 1990 99(6) 1772-8. 

Ceftriaxone is associated with biliary sludging or pseudo-cholithiasis due to precipitation of the drug in the bile. This occurs when its solubility in bile is exceeded when... 

Cholelithiasis is a common occurrence in the SCD patient. It is the result of the chronic hemolysis that results in increased bilirubin production, leading to biliary sludge and/or stone formation. Cholecystitis, exemplified by pain in the right iliac fossa, can be confused with abdominal pain crisis. ... 

On US a choledochal cyst will be seen as a cystic lesion with a thin wall, well defined borders, and echogenic material inside the cyst that corresponds to biliary sludge. However, it is important in the US evaluation to determine if the cyst is really a dilated choledochus, if the intrahepatic ducts are compromised, and if there is portal hypertension. As US has shown a specificity of 97% for choledochal cysts, it is widely used as the first diagnostic tool (Gubernick et al. 2000 Teele and Share 1991). 

In a prospective, open comparison of a 30-minute infusion of ceftriaxone and bolus administration in 32 children there was cholelithiasis in 3 and biliary sludge in 6 there was a trend to a lower incidence in those who were given ceftriaxone by infusion [19 ]. 

Bickford CL, Spencer AP. Biliary sludge and hyperbilirubinemia associated with ceftriaxone in an adult case report and review of the literature. Pharmacotherapy 2005 25(10) 1389-95. 

Biliary tract The frequencies of gallbladder sludge and cholelithiasis in 25 patients taking tacrolimus and 51 taking ciclosporin have been compared [86 ]. With tacrolimus the incidence of biliary sludge was 4% (1 of 25) and of gallstones 28% (7 of 25) the rates with ciclosporin were 4% (2 of 51) and 25% (13 of 51). 

---