Gallbladder Sludge?

[Xedp07a]

Hello,
I wrote earlier this week and got some great answers - I’m following up with some results and additional questions. am a 49-year-old white female with no prior digestive tract problems of any kind. Within the past year, I lost 50 pounds, which was about a 25% weight loss from my top weight of 192.
Earlier this week I had an ultrasound after going through several gallbladder-type attacks for the past few months. The results were that there were no specific stones and my gallbladder was thick-walled and contracted. The ultrasound tech was very thorough and scanned my entire abdomen; no other abnormalities were found (kidneys, spleen, liver, etc. were normal and there were no issues with any ducts). My doctor has ordered a HIDA scan for this coming week. The way it was explained to me, he felt that sludge was going to be found somewhere along the line.
The good news is that not every fatty food bothers me; in fact, it’s only the super-high fat foods like takeout and rich pastas that trigger the more serious attacks. For the first time, I had a lingering upper right abdominal pain after an attack on Saturday but that went away after 2 days…then it came back when the ultrasound was taken and the tech kept pushing on the gallbladder area. Now it’s an occasional twinge but overall I’m feeling pretty good.
Anyway, I have a few questions  that I probably should have asked the doctor but can’t now because he’s out of the office until next week. What is gallbladder sludge, and can it cause the same symptoms as a gallstone attack (I’m assuming so)? What causes the walls of the gallbladder to get thick or contract? Should I be worried about gallbladder cancer?
I’m not sure what to think, especially since I had the attacks but no gallstones.
Thank you in advance!

[Christopher R Watters, MD]

Yes, that is a Murphy sign. Radiologists refer to an ultrasonic Murphy sign when there is tenderness when the transducer is pressed on the gallbladder. Sounds like you have located the problem.

[Xedp07a]

The doctor mentioned the sludge when discussing the results of the ultrasound-they indicated that they felt pretty strongly that while no gallstones showed there would probably be this "sludge." I had fasted for 12 hours prior to the test, also.
When I was at the doctor for the initial exam, he had me lie flat, he pressed in the gallbladder area (where the pain was) and had me inhale deeply...I thought I was going to crawl out of my skin! I'm assuming that is the Murphy's sign?
Thank you for the information!!

[Christopher R Watters, MD]

What sludge are you referring to? You didn't describe any on the ultrasound.

The major weight loss that you had would certainly set you up for gallbladder disease. This is extremely common in the bariatric population. The contracted gallbladder is hard to read. Usually, it indicates chronic inflammation, especially with a positive ultrasonic Murphy sign (the tenderness over the gallbladder when the ultrasound transducer is pushed in). The HIDA is a reasonable test but it sounds like you have probably found the problem. I am assuming that you actually were NPO for 8 hours before the ultrasound exam. If you had had something to eat before the test this would be meaningless.