Biliary Sludge Formation Research Articles

Sonographic Detection of Fetal Cholelithiasis.

Fetal biliary lithiasis is a benign condition characterized by the presence of gallstones in the gallbladder of a developing fetus. It is typically detected incidentally during a routine obstetric echography. The incidence of this condition varies from 0.03% to 2.3%. In most cases, fetal cholelithiasis resolves spontaneously and has an excellent prognosis. However, there are certain risk factors that may contribute to its development. Maternal factors that increase the risk of fetal cholelithiasis include placental abruption, elevated estrogen levels, narcotic use, diabetes, enteral nutrition, and specific medications, such as ceftriaxone, furosemide, and prostaglandin E2. Fetal factors that can contribute to the condition include Rhesus or ABO blood group incompatibility, congenital anomalies affecting the cardiovascular, gastrointestinal, or urinary systems, twin pregnancies with the fetal demise of one twin, genetic anomalies such as trisomy 21, chromosomal aberrations, cystic fibrosis, growth restriction, oligohydramnios, hepatitis, or idiopathic causes. Usually, the gallstones spontaneously resolve before or after birth without requiring specific treatment. However, in rare instances, complications can arise, such as the formation of biliary sludge, inflammation of the gallbladder (cholecystitis), or obstruction of the bile ducts. If complications occur or if the gallstones persist after birth, further evaluation and management may be necessary. Treatment options can include medication, minimally invasive procedures, or, in severe cases, surgical removal of the gallbladder.

The strategy of laparoscopic surgery for asymptomatic antenatally diagnosed choledochal cyst

BackgroundThe aim was to investigate the characteristics, surgical management, and outcomes of asymptomatic patients with antenatally diagnosed choledochal cysts (ADCCs) and to justify the strategy of laparoscopic surgery (LS) for them in our hospital.MethodsWe developed our LS strategy for asymptomatic ADCCs. Patients with asymptomatic ADCCs who underwent LS or open surgery (OS) during January 2010 and January 2020 were included. Patients with recorded symptomatic ADCCs were exclude. All data of group LS and group OS were statistically compared and analyzed.ResultsTwenty-five patients received LS and 18 patients received OS were included. There was no significant difference in baseline characteristics between the groups. A total of 65.1% of biliary sludge formation was detected preoperatively by ultrasonography (US) (72.0% in group LS, 55.6% in group OS, P = 0.26). Compared to the OS group, the LS group had a longer operative time (313.4 ± 27.2 vs. 154.0 ± 11.9 min, P = 0.02), shorter postoperative fasting period (3.1 ± 1.2 vs. 6.2 ± 2.3 days, P = 0.03), and shorter postoperative hospital stay (5.1 ± 1.9 vs. 9.2 ± 1.1 days, P = 0.03). The incidence of late complications, such as reflux cholangitis, adhesive intestinal obstruction, and biliary enteric anastomotic stricture with stone formation, was not significantly different between the two groups. The liver function and liver stiffness of all patients in the two groups were normal.ConclusionsBased on the strategy for asymptomatic ADCCs in our hospital, the perioperative safety and midterm follow-up results after LS were satisfactory and comparable to those after OS.

Ceftriaxone-associated side effect findings in children’s abdominal ultrasonography

Ceftriaxone is a third-generation cephalosporin, which has a broad spectrum of activity against Gram-negative and Gram-positive bacteria. It can sometimes induce biliary sludge or stone formation because of the interaction with Calcium ions. The aim of this study is to describe the epidemiology of the side effects after the ceftriaxone therapy in hospitalized pediatric patients and to follow up the group of suspected Ceftriaxone-induced adverse effects. Methods: This prospective study was conducted in different Pediatric Services of the University Hospital Center “Mother Theresa”, Tirana, during the period October 2021-March 2022. We studied the ultrasonographic data of 80 patients admitted to these services, who had been on Ceftriaxone therapy. Results: All the females aged from 5-10 years old, and males aged from 6-12 years old, underwent ultrasound examination for other reasons and 21.25% of the cases resulted with pseudolithiasis, while 3.75% with nephrolithiasis. According to the total number of cases, 70.6% of them were asymptomatic. Only 29.4 % of the patients referred right upper quadrant pain and 1 of them showed nausea. The symptoms began from 5th-7th day and last 20 days. The ultrasound imaging performed from 5th- 10th days after Ceftriaxone administration, showed gallbladder sludge and pseudolithiasis in the symptomatic patients, ranged 8-12 mm, and renal microlithiasis <3mm. These patients were followed with ultrasound exam after 1 month. Conclusion: From all pediatric patients treated with Ceftriaxone and followed with ultrasonography, 21.25% resulted with collateral associated gallbladder pseudolithiasis as side effect from ceftriaxone-therapy, found by ultrasonographic evaluation. None of the cases was complicated with gallbladder hydrops, pancreatitis or hydronephrosis. After the Ceftriaxone therapy was discontinued, the condition resolved spontaneously. Key Words: ceftriaxone, gallbladder pseudolithiasis, nephrolithiasis, ultrasound

ODP378 Biliary Sludge in a Neonate with Congenital Hypothyroidism

Abstract Background Most cases of congenital hypothyroidism are asymptomatic. When signs are evident, they are nonspecific. Characteristic clinical findings, including prolonged jaundice are seen in less than 5% of affected neonates. Clinical Case Female newborn, full term, appropriate weight for gestational age, five days old, Kramer zone 3 jaundice. The laboratory ruled out hemolysis, blood group incompatibility and TORCH infections. Hepatobiliary ultrasound showed biliary sludge. The screening for congenital hypothyroidism reported a TSH value of 38 mlU/L; the free T4 value was analyzed and was low. With the diagnosis of congenital hypothyroidism, levothyroxine therapy was started. The biliary sludge disappeared two weeks after initiation of hormone therapy. Conclusion It is important to exclude other causes of biliary sludge formation, such as sepsis, parenteral nutrition, hemolytic disease, metabolic diseases, some drugs and pyloric stenosis. Congenital hypothyroidism may be associated with biliary sludge formation; thyroid hormones have an inhibitory effect on the contractility of the sphincter of Oddi. Presentation: No date and time listed

Acute necrotizing calculous cholecystitis after treatment with ceftriaxone in an elderly patient: a case report

BackgroundCeftriaxone, a third-generation cephalosporin antibiotic with a long plasma half-life, is widely used to treat various infections. The use of ceftriaxone can sometimes induce biliary sludge or stone formation. Although most cases of ceftriaxone-induced pseudolithiasis are asymptomatic or mild and resolve with discontinuation of the drug, we experienced an elderly case of severe acute necrotizing calculous cholecystitis after administration of ceftriaxone.Case presentationA 72-year-old male patient was admitted to our hospital because of acute diverticulitis in ascending colon. Ceftriaxone was administered at a dose of 2 g/day for 6 days. Although he recovered after therapy, he was readmitted about 2 weeks later because of severe pain with rebound tenderness in the right upper quadrant. An abdominal imaging study revealed stones and sludge in the gallbladder that were not observed before starting ceftriaxone therapy. Therefore, antibiotic treatment with flomoxef 2 g/day was indicated. However, on the fifth day of readmission, the peritoneal irritation symptoms in the right upper quadrant worsened, and elevated inflammatory response and liver dysfunction were observed. Cholecystectomy was performed based on these findings. The resected inflamed gallbladder showed acute necrotizing cholecystitis with sand granular gallstones. A comparative analysis of the infrared spectroscopic pattern of the composition of gallstones collected during surgery with that of the ceftriaxone powder revealed that both have very similar infrared spectroscopic patterns.ConclusionsCeftriaxone-related pseudolithiasis is generally reversible and mainly observed in children. Here, we report a rare case of ceftriaxone-related acute necrotizing cholecystitis in an elderly patient. We confirmed that the stones in the gallbladder are composed of ceftriaxone. The older age, dehydration, fasting, and long-time bed rest during the administration of high-dose ceftriaxone were the potential risk factors for gallstone formation.

A multicenter retrospective study assessing progression of biliary sludge in dogs using ultrasonography.

BackgroundBiliary sludge (BS) frequently is identified on ultrasonographic examination and is described as incidental. It is hypothesized that biliary stasis and hypersecretion play a role in both BS and gallbladder mucocele (GBM) formation. Recent studies have documented similarities in composition of BS and GBM, and there are several examples of progression from BS to GBM in the veterinary literature.ObjectivesTo assess the relationship between the presence of BS and later development of GBM in dogs, over time periods >12 months.AnimalsA total of 154 dogs with BS and ultrasonographic follow‐up >12 months.MethodsMedical records were retrospectively collected from 9 UK‐based referral centers for all available time points. A semiobjective scoring system was used to track volume of BS within the gall bladder (GB) over time.ResultsTwenty dogs developed GBM during the study period. Shetland Sheepdogs (odds ratio [OR], 40.99; 95% confidence interval [CI], 3.61‐465.95; P = .003) and Border Terriers (OR, 11.66; 95% CI, 3.28‐46.63; P < .001) were independent risk factors for the development of GBM. Non–gravity‐dependent BS (NDBS) was noted to form before GBM development in 9/20 dogs, and breeds at‐risk for GBM were more likely to have NDBS. Odds for the development of GBM increased with BS score.Conclusions and Clinical ImportanceDogs with NDBS may be at risk for the development of GBM and a stratified BS scoring system could allow for semiobjective monitoring over time, particularly in at‐risk breeds.

The incidence of biliary sludge in first trimester pregnancies with hyperemesis gravidarum and its effect on the course of hyperemesis gravidarum

Pregnancy is one of the risk factors for biliary sludge (BS) formation. In this cross-sectional study, a total of 959 pregnant women were included. Serum aspartate aminotransferase, alanine aminotransferase, sodium, potassium, triglycerides, cholesterol levels and the presence of ketones in urine were determined. The presence of BS was investigated using maternal abdominal ultrasound. The incidence of BS in pregnancies complicated by hyperemesis gravidarum (HG) was 14%. The degree of ketonuria and low birth weight were statistically higher in pregnancies with maternal BS than women without sludge. Total weight gain during pregnancies with BS was statistically lower than controls. The incidence of BS in pregnancies with HG does not appear to increase due to HG-related complications, such as dehydration, starvation and weight loss. However, the severity of HG may be worse when HG is associated with sludge. Impact Statement What is already known on this subject? The incidence of biliary sludge (BS) in pregnant women ranges between 10.9% and 36%. Some clinical conditions, such as pregnancy, prolonged fasting, total parenteral nutrition, rapid weight loss and ceftriaxone treatment can play a role in the formation of gallbladder sludge. What do the results of this study add? This is the first study to investigate the incidence of BS in hyperemesis gravidarum (HG) pregnancies. Results show that HG may transiently be associated with BS. HG is more likely to cause a transient increase in new sludge formation. The symptoms and complications related to HG may be more severe when HG is associated with BS. What are the implications of these findings for clinical practice and/or further research? Our study showed that BS can be found in HG patients, and HG can be a predisposing factor for new sludge formation, although this association is generally driven by advanced maternal age and increased baseline serum lipid and alanine aminotransferase levels. BS may also be independently associated with an increased risk of subsequent preterm delivery in women with HG.

Risk Factors Associated with Cholelithiasis during Pregnancy and Postpartum

Gallbladder disease is the most common non-obstetrical cause of maternal hospitalization in the first year postpartum. Many risk factors have been associated with gallbladder disease in pregnancy including body mass index, prenatal weight gain, prenatal physical activity, dietary fat, age, parity, a history of gallbladder disease and the number of previous pregnancies were significant factors related to new gallstones and biliary sludge formation in the pregnant group. The aim of this study is to evaluate the risk factors for gallstones formation in pregnancy and one year after labour. The study included 328 female patients (pregnant or postpartum) divided into two groups; patient group (164 patient) that are pregnant or postpartum patient have gallstones and control group (164 patient) that are pregnant or postpartum patient does not have gallstones. All patients were subjected to full history taking; especially about risk factors predisposing for gallstones, physical examination and pre-operative routine laboratory investigations and imaging as abdominal ultrasound study (U/S). Obesity, young age, history of gallbladder disease and use of estrogen and progesterone are the main risk factors that increase incidence of gallstones during pregnancy or one year postpartum. Use of vit C, iron, drinking coffee and practicing regular physical activity are considered protective factors.

Цефалоспорин-асоційований біліарний псевдолітіаз у дітей

Стаття присвячена біліарному холелітіазу, асоційованому з застосуванням цефалоспоринів, у дітей. В огляді представлений аналіз епідеміологічних даних, розкриті механізми формування біліарного сладжа, систематизовано чинники ризику розвитку, охарактеризовані особливості клініки, діагностики та лікування псевдолітіазу в дітей. Для написання огляду здійснювався пошук інформації з використанням баз даних Scopus, Web of Science, MedLine, PubMed, Google Scholar, CyberLeninka, РІНЦ.

Цефалоспориніндукований біліарний сладж у дітей

Актуальність. Одним із побічних ефектів дії цефалоспоринів ІІІ покоління є формування цефалоспориніндукованого біліарного псевдолітіазу (ЦІБПЛ). Мета. Вивчити особливості формування біліарного сладжа при застосуванні цефалоспоринів ІІІ покоління в терапії гострих респіраторних інфекційних захворювань у дітей. Матеріали та методи. Обстежено 46 дітей віком від 2 до 15 років з гострими респіраторними інфекційними захворюваннями, які отримували в терапії цефалоспорини ІІІ покоління парентеральним шляхом введення у вікових дозах. У всіх дітей до початку лікування і після закінчення антибіотикотерапії оцінювали показники біохімічного дослідження крові і дані ехосонографії (ультразвукове дослідження) біліарного тракту. Результати. За даними УЗД у 10 пацієнтів (21,7 %) з гострими респіраторними інфекційними захворюваннями після проведеного курсу терапії цефалоспоринами ІІІ покоління виявлено неоднорідний вміст у просвіті жовчного міхура у вигляді гіперехогенного субстрату, що свідчило про формування ЦІБПЛ. Середній вік пацієнтів із ЦІБПЛ становив 9,05 ± 1,44 року і перебував у межах від 4 до 15 років. Встановлено, що у 60 % обстежених дітей формування ЦІБПЛ протікало субклінічно. Результати біохімічного дослідження сироватки крові показали, що у дітей із ЦІБПЛ спостерігалося підвищення активності аланінамінотрансферази, аспартатамінотрансферази і лужної фосфатази. Було встановлено, що ЦІБПЛ відзначається у 22,9 % дітей на тлі терапії цефтріаксоном, у 9 % пацієнтів — цефтазидимом. Біліарний сладж формувався у 54,5 % хворих, які отримували цефтріаксон у високих дозах (100 мг/кг/добу), і в 75 % випадків — після 10-денного застосування даного антибіотика. Висновки. Отримані результати показали, що на тлі застосування цефалоспоринів ІІІ покоління при терапії гострих респіраторних інфекційних захворювань у 21,7 % хворих дітей відбувається формування ЦІБПЛ. Особливо високий ризик розвитку ЦІБПЛ відзначається при використанні високих доз цефтріаксону і пролонгованої терапії цефалоспоринами.

The Mystery of Acidosis

We present a case of 30-year-old female with past medical history of Type 2 DM, Thyroid nodule and asymptomatic cholelithiasis who presented to ED with abdominal pain, vomiting and sinus tachycardia of 120’s for past one day. She had generalized abdominal pain, not relieved by pain killers. Her lab test includes normal blood count, glucose 150mg/dl, anion gap of 20, metabolic acidosis. Her ultrasound abdomen showed cholelithiasis with no biliary sludge formation. Given her acidosis and severe abdominal pain she was started on Zosyn and underwent cholecystectomy. Her abdominal pain and sinus tachycardia did not resolve till day 3 of admission. Urine was positive for ketones. On chart review, it was found that she started taking sodium glucose transporter 2 inhibitor (SGLT-2 inhibitor), Canagliflozin. She was given IV fluids and insulin. She improved and her tachycardia resolved. Euglycemic acidosis is a rare phenomenon but frequently misdiagnosed. This case emphasizes on importance of side effects of oral glucose lowering agents. SGLT-2 inhibitors can cause lipolysis and ketosis while maintaining euglycemia. Prompt clinical judgement is needed to prevent misdiagnosis. Also, patients should be educated about aggravating factors like stress, dehydration or other severe illnesses.

Ceftriaxone-Associated Gallbladder Pseudolithiasis in a Pediatric Patient, Case Report and Review of the Literature

Ceftriaxone plays a vital role in modern medicine due to its broad-spectrum coverage of common microbes. A relatively frequent, yet underplayed side effect is pseudolithiasis, especially in the pediatric setting. While most cases resolve spontaneously, there have been reports of patients requiring surgical treatment after developing further complications. We report a case of an abrupt onset (<3 days) pseudolithiasis occurring after just four moderate doses of Ceftriaxone. A previously healthy 2 years and 9-month-old girl was admitted as a case of exudative tonsillitis with secondary gastroenteritis. On day three of Ceftriaxone treatment, sudden onset severe abdominal pain ensued which warranted an abdominal ultrasound showing multiple gallbladder stones. Consequently, Ceftriaxone was changed to Cefotaxime and the pain subsided following a further two inpatient days and outpatient follow-up appointments were scheduled. Ceftriaxone has a high elimination in the bile, which gives predominance for potential biliary complications. It is well documented that high and prolonged doses increase the likelihood of these complications. In our case the accelerated progression of the pseudolithiasis could be due to the dehydration caused by the background gastroenteritis. Reduced oral intake and dehydration causes biliary stasis which accelerates the formation of biliary sludge and gallbladder precipitates due to biliary stasis. In the future, physicians could reconsider the use of ceftriaxone in patients with similar presentations.

A fully covered self-expandable metallic stent coated with poly (2-methoxyethyl acrylate) and its derivative: In vitro evaluation of early-stage biliary sludge formation inhibition

The adhesion and deformation behavior of proteins at the inner surface of fully covered, self-expandable metallic stents coated with biocompatible polymers, poly(2-methoxyethyl acrylate) (PMEA) and poly(3-methoxypropyl acrylate) (PMC3A), were analyzed. Model bile solution, proteins, and bacteria were used to unravel the inhibitory ability of the polymer coatings. Adsorbance of proteins and adherence of bacteria were both strongly inhibited by the polymer coatings. Circulation tests were performed under clinical conditions using human bile from patients. Adsorption/deformation of proteins and early-stage sludge formation were inhibited on stent surfaces coated with PMEA derivatives. The present study revealed that early-stage biliary sludge formation on PMEA- and PMC3A-coated stents was suppressed due to the strong resistance of the polymers to protein adsorption/deformation, brought about by intermediate water in hydrated polymer coatings, which is not present in conventional coating materials, such as silicone and polyurethane.

Metallic Stent Mesh Coated with Silver Nanoparticles Suppresses Stent-Induced Tissue Hyperplasia and Biliary Sludge in the Rabbit Extrahepatic Bile Duct.

Recent therapeutic strategies to suppress restenosis after biliary stent placement are insufficient. Here, we demonstrate the usefulness of a self-expandable metal stent (SEMS), a stent mesh coated with silver nanoparticles (AgNPs), for suppression of both stent-induced tissue hyperplasia and biliary sludge formation in the rabbit bile duct. The AgNP-coated SEMSs were prepared using a simple bio-inspired surface modification process. Then, the prepared SEMSs were successfully placed in 22 of 24 rabbits. Sludge formation in the AgNP-coated SEMS groups was significantly decreased compared to the control group on gross findings. Cholangiographic and histologic examinations demonstrated significantly decreased tissue hyperplasia in the AgNP-coated SEMS groups compared with the control group (p < 0.05 for all). There were no differences between the AgNP-coated SEMS groups (p > 0.05 for all). However, in the group coated with the greatest concentration of AgNPs (Group D), submucosal fibrosis was thicker than in the other AgNP-coated groups (p < 0.05 for all). The AgNP-coated metallic stent mesh significantly suppressed stent-induced tissue hyperplasia and biliary sludge formation in the rabbit bile duct. Taken together, the AgNP coating strategy developed in this study could be widely utilized in non-vascular medical devices for anti-bacterial and anti-inflammatory responses.

The association between eating difficulties and biliary sludge in the gallbladder in older adults with advanced dementia, at end of life.

ObjectivesIn clinical settings, untreatable biliary sludge in the gallbladder can be observed in older adults with advanced dementia. The underlying cause of biliary sludge existence in patients with dementia is currently unknown. Therefore, we aimed to investigate the prevalence, risk factors, and related outcomes of biliary sludge formation in the gallbladder of older adults with dementia.DesignCross-sectional study.SettingGeriatric ward of University Hospital in Japan.ParticipantsInpatients aged 80 and older living with dementia.MeasurementsWe evaluated the presence of biliary sludge by diagnostic ultrasonography and collected data regarding patient demographic information, cognition (mini-mental state examination [MMSE]), physical activity (Barthel Index), oral food intake (food intake level scale [FILS]), clinical stage of dementia (functional assessment staging [FAST] of dementia), and patient performance status (Zubrod/ Karnofsky score).ResultsMale sex, larger gallbladder volume and calories from oral intake were significantly associated with the presence of biliary sludge (P = .02, .02, .002, respectively). There was a significant negative correlation between the FAST stage and the FILS level in all patients (P < .001). More advanced dementia and dysphagia was more likely to be found in patients with Alzheimer disease (AD) with biliary sludge, compared to patients with AD without biliary sludge (FAST 7a, FILS II and FAST 6c, FILS V, respectively, P = .06, 04). A logistic regression analysis revealed that the eating status of FILS I and II, generally called “fasting or anorexia”, was a significant risk factor for forming biliary sludge in older adults with dementia (P = .031, odds ratio: 5.25, 95% confidence interval: 1.16–23.72).ConclusionsFasting status may be associated with the existence of biliary sludge in older adults with dementia. Therefore, supportive care for eating might be an important solution to comfortable end-of-life care for older adults with advanced dementia.

Modern approaches to treatment of patients with biliary sludge: how to choose optimal scheme?

Currently, biliary sludge (BS) is considered as a pathological process associated with an increase in the lithogenicity of bile and according to the modern classification of gallstone disease referred to the prestone stage of the disease. In the mechanism of BS formation, the main role belongs to four factors: glut of bile with cholesterol, formation of crystallization nucleus, dysfunction of the gallbladder (contraction, absorption, secretion), violation of the enterohepatic circulation of bile acids. Clinical manifestations in BS are most often associated with concomitant functional disorders of the biliary tract and chronic bacterial duodenitis with duodenal hypertension. The main directions in the treatment of BS are reduced to the restoration of the normal rheological properties of bile, the normalization of the motor function of the biliary system and the duodenum, the correction of the intestinal microbiome. The article discusses effective treatment regimens for BS depending on its morphological features and clinical course with the use of ursodeoxycholic acid or hofitol. The mechanism of Chophytol action (Mayoly Spindler, France) at BS is presented. The additional use of Meteospasmyl in the presence of intestinal antiseptic indications contributes to the rapid resolution of clinical manifestations in this pathology.

Lack of a liver‐specific apolipoprotein (apo)A‐V in bile promotes cholesterol gallstone formation by disrupting biliary cholesterol homeostasis in mice

BackgroundApoA‐V is synthesized exclusively by the liver and secreted into the circulation, involving in plasma lipoprotein and lipid metabolism. Although its concentration in human plasma is extremely low (114–258 ng/mL), 1,000 to 10,000‐fold lower than that of apoB‐100 and apoA‐I, respectively, human and mice lacking functional apoA‐V suffer from hypertriglyceridemia. Because our new results found that apoA‐V is also secreted into bile, we hypothesize that it plays an important role in regulating biliary cholesterol metabolism, and its deficiency reduces cholesterol solubility in bile, promoting cholesterol crystallization and gallstone formation.MethodsTo explore the lithogenic mechanisms of biliary apoA‐V deficiency, male apoA‐V knockout (KO) and wild‐type (WT) mice (n=10 per group) were fed a lithogenic diet for 4 wk. Gallstones and cholesterol crystallization in bile were examined by physical‐chemical methods. Hepatic lipid output was determined by biliary secretion studies. Gene expression and protein content were analyzed by qRT‐PCR, Western blots, and ELISA.ResultsCompared to the chow diet, feeding the lithogenic diet significantly (P&lt;0.01) reduced hepatic apoA‐V mRNA and protein levels by 55% and its bile concentrations from 45.7±12.4 ng/mL to 16.7±6.0 ng/mL in WT mice. ApoA‐V was associated only with vesicles, but not micelles, in bile of WT mice. Biliary cholesterol, but not phospholipid or bile salt, output was higher (P&lt;0.05) in KO mice (29.0±8.5 μmol/h/kg) than in WT mice (20.4±5.5 μmol/h/kg), leading to cholesterol‐supersaturated bile. The deficiency of apoA‐V in bile reduced biliary cholesterol solubility and promoted cholesterol crystallization through the liquid crystalline pathway by enhancing biliary unilamellar vesicle aggregation and fusion to form unstable multilamellar vesicles in KO mice. After 50 ng/mL of apoA‐V protein isolated from WT mice was added to supersaturated model bile, cholesterol crystallization was significantly delayed than that added the protein at 0 ng/mL. This implies that apoA‐V plays a key role in regulating cholesterol solubility in bile by modulating the physical state of cholesterol carriers. In addition, the lack of apoA‐V impaired gallbladder emptying and refilling function, thus promoting the accumulation of excess mucin gel and the formation of biliary sludge, a precursor of gallstones. These abnormalities enhanced the growth and agglomeration of solid cholesterol crystal into microlithiasis. After 4 wk of feeding, gallstone prevalence was higher (P&lt;0.05) in KO mice (60%) than in WT mice (25%).ConclusionsThese findings clearly demonstrate that the liver‐specific protein apoA‐V plays a critical role in the regulation of biliary cholesterol metabolism and transport, and its lack in bile dramatically enhances cholelithogenesis by disrupting biliary cholesterol homeostasis. Increasing biliary apoA‐V may be a novel and efficient approach for the prevention of cholesterol gallstones.Support or Funding InformationThis work was supported in part by research grants DK101793, DK106249 and AA03557, all from the National Institutes of Health (US Public Health Service).This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Prevalence of gallstones and biliary sludge formation during pregnancy detected by ultrasonography

The risk of gallstones is thought to increase with number of pregnancies. Cholesterol gallstones are more prevalent in women than men and primarily related to sex steroids, particularly progesterone. During pregnancy there are changes in bile composition and gallbladder motility that promote gallstone formation. This study was conducted to determine incidence and outcome of pregnancy related biliary sludge and gallstone formation. Two hundred and nine consecutive expectant women were evaluated by ultrasonography at 1st trimester, 3rd trimester and at 4-6 weeks after delivery. Socio-demographic, medical and obstetrical history were taken and recorded. Incidence of gallstone and sludge formation were found 5.7% and 2.9%, respectively. The results suggest that pregnancy may be a risk factor for gallstone and biliary sludge formation.Mediscope Vol. 4, No. 2: Jul 2017, Page 21-24

Gallbladder Ejection Fraction and Sphincter of Oddi Dysfunction in Acute Idiopathic and Acute Recurrent Pancreatitis in Children

Background and Aim: Gallbladder (GB) dysfunction leading to biliary sludge formation and sphincter of Oddi dysfunction (SOD) are the important causes of idiopathic acute pancreatitis (idiopathic AP) and acute recurrent pancreatitis (ARP) in adults. However, this is not investigated in children. We prospectively evaluation for gallbladder (GB) dysfunction and sphincter of Oddi dysfunction (SOD) in children with idiopathic and recurrent AP. Methods: All consecutive patients of idiopathic AP and ARP underwent 99mTc Mebrofenin Hepatobiliary Scintigraphy with intravenous tracer injection for 1 h. Subsequent premeal and postmeal static images following standard fatty meal administration were acquired up to 4 h for maximum gallbladder ejection fraction (GBEF) and hold up of radiotracer in the CBD. GBEF ≤ 35% is considered abnormal. Results: At total of 14 AP (male 50%) and 20 ARP (male 45%) patients underwent scintigraphy. Over all 11.7% (4 of 34) of the patients had poor GB contraction. The mean ± SD of GBEF in AP and ARP were 55.45 ± 24.05 and 56.10 ± 16.92 respectively. In AP and ARP groups, 21.4% (3 of 14) and 5% (1 of 20) had GB dysfunction (GBEF≤35%) respectively. There were no confirmed cases of sphincter of Oddi dysfunction (SOD). There was no stone or sludge in 4 patients with low GBEF. Conclusion: Among AP and ARP, 11.7% of patients had poor GB contraction. There was no sludge, microlithiasis or GB stone in patients with poor GBEF. The authors have none to declare.

Comparative evaluation of ceftriaxone- and cefotaxime-induced biliary pseudolithiasis or nephrolithiasis: A prospective study in 154 children

Biliary lithiasis, or sludge, and nephrolithiasis have been reported as a possible complication of ceftriaxone therapy. However, no study related to cefotaxime-induced biliary pseudolithiasis or nephrolithiasis was observed in the literature. Therefore, we investigated the comparative formation of biliary pseudolithiasis and nephrolithiasis after cefotaxime and ceftriaxone therapies. The patients treated with ceftriaxone or cefotaxime were enrolled during the study period. Ultrasound imaging of the biliary and urinary tract was performed in all patients before and after the treatment. The patients with a positive sonographic finding at the end of treatment were followed up with monthly ultrasonography for 3 months. The present study showed that abnormal biliary sonographic findings were demonstrated in 18 children (20.9%) treated with ceftriaxone, 13 (15.1%) had biliary lithiasis, 5 (5.8%) had biliary sludge and 1 (1.2%) had nephrolithiasis. Abnormal biliary sonographic findings were demonstrated in only four (5.9%) children treated with cefotaxime who had biliary sludge and only one (1.5%) had nephrolithiasis. It was observed that older age was at significantly higher risk of developing biliary sludge or stone formation. Receiver operating characteristic analysis was performed to determine the residual risk and analysis found that 4.5 years was the cut-off value for age. The present study is unique in the literature for reporting for the first time gall bladder sludge and nephrolithiasis associated with cefotaxime use. Therefore, patients treated with cefotaxime should be monitored for serious complications like patients treated with ceftriaxone. Nevertheless, if third-generation cephalosporin is used, cefotaxime is recommended to be used rather than ceftriaxone.