ORIGINAL STUDIES

Gallbladder Sludge in Dogs: Ultrasonographic and

Clinical Findings in 200 Patients
Audrey K. Cook, BVM&S, DACVIM, DECVIM, DABVP (Feline), Anisha V. Jambhekar, DVM*, Allison M. Dylewski, DVM†

ABSTRACT
Echogenic luminal contents are often noted during ultrasonographic examination of the gallbladder (GB) in canine
patients, but the significance of biliary sludge is not well understood. GB contents were evaluated during 200 sequential
ultrasonographic scans performed at a veterinary school, and sludge was quantified using a 1–5 scale. GB volume was
retrospectively estimated from stored images. Medical records were used to determine patient demographics,
clinicopathologic findings, and diagnoses/disorders. The majority of dogs (66.5%) had some hyperechoic material
within the GB. Four dogs were diagnosed with a mucocele. For statistical purposes, dogs with uniformly nonechogenic
bile or minimal sludge (80.5%) were compared to those with .25% sludge (17.5%). Dogs with .25% sludge were
significantly older than those with minimal sludge (8 versus 11 yr). Serum cholesterol and bilirubin concentrations and
activities of both alkaline phosphatase and gamma-glutamyl transferase were not correlated with the presence of GB
sludge. Dogs with spontaneous hyperadrenocorticism or hypothyroidism were more likely to have .25% sludge (odds
ratio: 5.04). In addition, .25% sludge was associated with increased GB volume, suggesting that changes in GB
function or contractility may impact the formation of biliary sludge in dogs. (J Am Anim Hosp Assoc 2016; 52:125–131. DOI
10.5326/JAAHA-MS-6282)

Introduction GB accompanied by hyperplasia of the mucus-secreting epithelium.

The biliary tract is routinely examined during ultrasonographic
(US) scans in dogs, and the contents of the gallbladder (GB) are
easily evaluated. These may be uniformly nonechogenic, with no
evidence of solid debris. Alternatively, variable amounts of biliary
sludge, defined as gravity-dependent hyperechoic variably partic-
1
ulate material without acoustic shadowing, may be noted. Less
commonly, GB contents may appear solid and non–gravity
dependent. The presence of radial hyperechoic striations within
this solid material and a hypoechoic rim suggests a GB mucocele
1,2
(MC). This is defined as an accumulation of mucin within the
Although choleliths appear to be relatively uncommon in dogs,
these are characterized as markedly hyperechoic structures with
acoustic shadowing. Depending on the density of the surrounding
bile, these are generally mobile and gravity dependent.
In human patients, biliary sludge is a complex mixture of
cholesterol crystals, bile pigments, and bile salts, embedded in
mucin.3 This material often includes particles 1 mm, referred to
as microliths, which are thought to precede gallstone formation.3
People with sludge and microlithiasis may report colicky pain and
postprandial discomfort. Intervention is recommended to prevent

From the Department of Small Animal Clinical Sciences, College of
Veterinary Medicine and Biomedical Sciences, Texas A&M
University, College Station, TX.
Correspondence: akcook@cvm.tamu.edu (A.K.C)
ALP (alkaline phosphatase); BCS (body condition score); CI
(confidence interval); DM (diabetes mellitus); GB (gallbladder); GGT
(gamma-glutamyl transferase); HAC (hyperadrenocorticism); HT
(hypothyroidism); MC (mucocele); US (ultrasonographic)
*
A. Jambhekar’s present affiliation is the Department of Veterinary
Clinical Medicine, College of Veterinary Medicine, University of Illinois
at Urbana Champaign, Urbana, IL.
†
A. Dylewski’s present affiliation is Northwest PA Pet Emergency
Center, Erie, PA.

Q 2016 by American Animal Hospital Association JAAHA.ORG 125


TABLE 1
Grading Scale for Ultrasonographic Assessment of Gallbladder
Sludge in Dogs
Grade Description
1 Bile uniformly hypoechoic; no sediment
2 1–25% of bile hyperechoic; gravity dependent
3 26–50% of bile hyperechoic; gravity dependent
4 51–75% of bile hyperechoic; gravity dependent
5 .75% of bile hyperechoic
MC Solid, hyperechoic, non–gravity dependent; hyperechoic striations
cholelithiasis and often includes ursodeoxycholic acid (ursodiol)
and cholecystectomy.4 The composition of spontaneous biliary
sludge in dogs has not been reported, but low incidence of
gallstones in this species compared to people suggests that canine
sludge may have a different composition or etiology.5 This is
supported by experimental studies indicating that canine biliary
sludge does not contain substantial amounts of cholesterol.6–8
The clinical implication of biliary sludge in dogs is unclear. An
early study suggested a weak association between sludge and
patient age but did not identify a connection to naturally occurring
hepatobiliary disease.9 It was concluded that GB sludge should be
considered an incidental finding in this species. This is somewhat
contradicted by a later study, in which mobile sludge or precipitate
was reported in 24/45 dogs with GB disease; nine of these 24
(37.5%) ruptured.1 More recently, abnormal GB contents (both
sludge and MC) were associated with impaired emptying following
a meal challenge in dogs.10 However, it was not determined if
decreased GB contractility was the cause or consequence of the
abnormal contents.
In recent years, both genetic and metabolic factors have been
implicated in MC formation in dogs. An insertion mutation in the
ABCB4 gene was identified in 14/15 affected Shetland sheepdogs,
but not in 20/21 unaffected individuals, and may explain the
predisposition of this breed to MC formation.11 This mutation
impairs secretion of a protective phospholipid across the
canalicular membrane, thereby making the GB epithelium more
vulnerable to the irritant properties of bile. In a retrospective study
of 78 dogs diagnosed with MC, age- and breed- matched controls
12
were used to identify the impact of a concurrent endocrinopathy.
In this population, the odds of MC in dogs with hyperadrenocor-
ticism (HAC) were 29 times that of dogs without HAC. A weaker
association was found for hypothyroidism (HT), with a threefold
increased risk. Although various sources suggest that sludge may
precede MC formation, there is presently little direct evidence to
126 JAAHA | 52:3 May/Jun 2016
support this hypothesis, and similar influences have not been
reported for biliary sludge.13,14
The goals of this study were to determine the prevalence of
echogenic material (‘‘sludge’’) within the GB of dogs undergoing
routine diagnostic abdominal US examination at a veterinary
teaching hospital, to describe population characteristics for dogs
with minimal versus substantial (.25%) GB sludge, to evaluate
and compare selected clinicopathological data for dogs from these
subsets, and to identify the impact of concurrent endocrine
disorders on GB contents.
Materials and Methods
A grading scheme was created to allow crude quantification of the
percentage of hyperechoic material within the GB, as determined
during real-time US examination (Table 1). This grading tool was
then used to score GB contents in 200 sequential examinations
performed on canine patients undergoing routine abdominal
studies at Texas A&M University Veterinary Medical Teaching
Hospital from November 2009–April 2010. All US scans were
performed by Diplomates of the American College of Veterinary
Radiology or a radiology resident under direct supervision of a
board-certified radiologist. Two different US systemsa,b were used,
depending on availability and radiologist preference. Transducer
type and frequency were selected by the attending radiologist based
on patient size, configuration, and imaging characteristics.
Patients were positioned in dorsal or lateral recumbency
during the examination, depending on radiologist preference.
Sedation was administered as necessary at the direction of the
attending clinician. Although fasting is recommended at this
institution prior to US examination, patients were variably fed
within the preceding 8 hr. Contemporary standard of care was
provided to each animal.
For each dog, the contents of the GB were assessed during the
US scan, and the findings were recorded immediately following the
examination. The amount of sludge (if present) was estimated as a
percentage of total GB contents during several seconds of scanning
time, using views from various angles, including longitudinal and
sagittal views. The GB contents were classified as consistent with a
MC if the overall appearance matched that described in the current
veterinary literature, i.e., essentially solid, non–gravity dependent,
hyperechoic bile with hyperechoic striations, creating a starfish/
kiwifruit appearance.1,2 Results were excluded from the final
analysis if the patient had previously been scored. Still images were
collected by the radiologist during the study and stored in a digital
image archive. A detailed written description of the US findings
was generated for each case within 3 d of the examination and
included in the computerized medical record.

TABLE 2
Results of Ultrasonographic Gallbladder Scoring in 200 Canine
Patients
Grade Number (%) of Dogs
1 67 (33.5%)
2 94 (47%)
3 26 (13%)
4 5 (2.5%)
5 4 (2%)
MC 4 (2%)
GB volume was estimated from stored digital images using a
modification of the method proposed by Dodds et al., in which
width was substituted for height.15 Measurement of length and
width were determined from long axis images in which the neck of
the GB was evident. If more than one long axis image was available,
the one with the greater longitudinal dimension was used. GB
volume was calculated using the following equation:
Volume ¼ Length ðmmÞ 3 width ðmmÞ 3 width ðmmÞ 3 p=6
p=6 approximated to 0:52
GB volumes were then indexed for body weight in kilograms.
Information regarding patient age, breed, gender, and weight
was obtained from computerized medical records. A body
condition score (BCS) was derived from documents within the
medical record and converted (if necessary) to a 9-point scale.
Clinicopathological data reported within 24 hr of US scanning were
reviewed; serum cholesterol and bilirubin concentrations and
alkaline phosphatase (ALP) and gamma-glutamyl transferase
(GGT) activities were recorded. Serum biochemical analyses were
all performed at the in-house clinical pathology laboratory using an
automated analyzerc. Medications administered within the previ-
ous 8 wk were noted, including sedatives administered to facilitate
ultrasonography.
One of the authors (A.K.C. a board-certified internist)
reviewed each medical record and classified the patient into one
of eight disease groups based on the reason(s) for performing
ultrasonography, clinical complaints, and final diagnoses. These
disease groups were hepatobiliary (icterus, increased enzyme
activity, hyperammonemia), endocrine (diabetes mellitus [DM],
HAC), urinary (renal, bladder, prostatic), gastrointestinal (includ-
ing pancreatic), neurologic, neoplastic, thoracic, and other
(immune mediated/ nonspecific/systemic/undefined).
Patients were classified as having spontaneous HAC if the
attending clinician listed this diagnosis in the visit summary.
Gallbladder Sludge in Dogs
Patients diagnosed by the attending clinician with inadequate
thyroid function and those receiving thyroid supplementation at
the time of examination were classified as HT. The appropriateness
of a prior diagnosis of HT was not investigated, and the efficacy of
therapy for dogs on thyroid supplementation was not evaluated. A
diagnosis of DM was listed for any patient with blood glucose
.200 mg/dl (reference range: 65–130 mg/dl) or currently receiving
insulin therapy.
Statistical analysis of the data was performed using a
commercial software programd; findings were considered signifi-
cant if P , 0.05. Where appropriate, data sets were tested for
normality using the D’Agostino and Pearson omnibus normality
test. The median values of selected data sets were compared using
the Mann-Whitney test for unpaired data. Fischer’s exact test was
used to compare population characteristics. Odds ratios are
reported with a 95% confidence interval (CI).
Results
Abnormal GB contents were noted in 133 dogs (66.5%) (Table 2).
Almost half (47%) of the dogs examined had a small amount of
echogenic material within the GB lumen (,25% of total GB
contents). Four dogs (2%) had .75% hyperechoic bile (grade 5
sludge), and four (2%) were categorized as having a MC. For
statistical purposes, dogs with normal to minimally abnormal bile
(i.e., grades 1 and 2; n ¼ 161: 80.5%) were compared to those with
.25% sludge (grades 3–5; n ¼ 35: 17.5%). Dogs with a MC (n ¼ 4)
were considered separately.
Suitable images for estimating GB volume were available for
all but six dogs (all graded 1 or 2). The median volume for dogs
graded 1 and 2 was 0.73 ml3/kg (range 0.08–3.65 ml3/kg); this was
significantly less than for those graded 3–5 (1.04 ml3/kg; range
0.31–7.86 ml3/kg; P , 0.001; Figure 1).
Patients ranged in age from 0.25–17 yr, with a median of 9 yr.
The median age for dogs graded 1 and 2 was 8 yr; this was
significantly lower than for the dogs with grade 3–5 sludge (11 yr; P
, 0.0002; Figure 2). A total of 41 breeds were listed in the study
population, with Labrador retriever (n ¼ 20), Yorkshire terrier (n ¼
16), and miniature schnauzer (n ¼ 15) most frequently reported.
Thirty-one dogs were of mixed breeding. Breed lists for dogs with
grade 1 and 2 sludge were similar to those with grade 3–5, and no
breed predispositions were noted. Overall gender distribution was
evenly divided, with 54% female and 46% male, and was similar for
dogs with grade 1 and 2 sludge and those with grade 3–5. Median
body weight for both subsets was 12.1 kg, with a range of 1–63.8 kg.
BCS was available for 50 dogs graded 1 and 2 (median: 5; range 2–
9) and 11 dogs graded 3–5 (median 6; range 5–9); these results were
not significantly different.
JAAHA.ORG 127

FIGURE 1 Vertical scatter plot showing estimated gallbladder
volumes for dogs with contents graded 1 and 2 (n ¼ 159) and 3–5 (n ¼
35). The median volume for each group is indicated by the horizontal
line. The median volume for dogs graded 1 and 2 was 0.73 ml3/kg;
median volume for dogs graded 3–5 was 1.04 ml3/kg (P , 0.001).
One data point is outside the axis limits and is not shown.
Contemporaneous laboratory findings were available for 142
dogs graded 1 and 2 (88.2%) and 34 dogs graded 3–5 (97.1%).
Median serum cholesterol concentration (reference range: 120–147
mg/dl) for dogs graded 1 and 2 was 219 mg/dl (range: 53-861 mg/
dl); this was not significantly different from that for dogs graded 3–
5 (242 mg/dl; range 88–643 mg/dl). Serum bilirubin concentrations
(reference range: 0–0.8 mg/dl) were similar for the two patient
subsets, with medians of 0.2 (range: ,0.1–14.6 mg/dl) and 0.3 mg/
dl (range: ,0.1–12.9 mg/dl), respectively. ALP activities (reference
range: 24–147 U/L) were also similar: the median for dogs graded 1
and 2 was 161 U/L (range 20–5259 U/L); the median for dogs
graded 3–5 was 183 U/L (range: 20–5202 U/L). Median GGT
activity (reference range: 0–25 U/L) was not significantly different
for dogs graded 1–2 (11 U/L; range 8–284 U/L) compared to the
grade 3–5 group (12 U/L; range 8–122 U/L).
The majority of patients (124; 62%) were sedated prior to
ultrasonography, primarily with opioids such as butrophanol (n ¼
74), buprenorphine (n ¼ 27) and fentanyl (n ¼ 9). Sedation did not
appear to impact GB score, with a median score of 2 for both
sedated and nonsedated dogs. GB volumes were also similar for the
sedated and nonsedated dogs, with median values of 0.89 ml/kg
and 0.75 ml/kg, respectively.
Only 26 dogs (13%) underwent ultrasonography for suspected
or established hepatobiliary disease. None of these patients had an
128 JAAHA | 52:3 May/Jun 2016
FIGURE 2 Vertical scatterplot showing age (in yr) of dogs with
gallbladder contents graded 1 and 2 (n ¼ 161) and 3–5 (n ¼ 35). The
median age for each group is indicated by the horizontal line. The
median age for dogs graded 1 and 2 was 8 yr; the median age for dogs
graded 3–5 was 11 yr (P , 0.0002).
MC, but the proportion of dogs with grade 3–5 sludge was higher
than for dogs without hepatobiliary disease (30.7% versus 15.9%;
odds ratio: 2.65; CI 1.03–6.80; P ¼ 0.048). The most common
reason for ultrasonography was gastrointestinal disease, with 49
(24.5%) of dogs, followed by 41 (20.5%) dogs with neoplastic
disease and 34 (17%) with urinary tract disorders.
Eleven dogs underwent ultrasonography for evaluation of a
suspected or known endocrinopathy, although concurrent HAC,
HT, or DM was reported in 26 dogs (13%). Three patients were
diagnosed with more than one endocrinopathy. HT was the most
common endocrinopathy, affecting 16 (8%) dogs, all of which were
diagnosed prior to this visit; DM was reported in eight dogs (4%)
and HAC in five dogs (2.5%).
Overall, the prevalence of an endocrinopathy (DM, HT, or
HAC) in dogs with grade 3–5 sludge was similar to that in dogs
with grade 1 and 2 sludge (17.1 % and 10.6%, respectively).
However, dogs with HAC and/or HT were substantially more likely
to have grade 3–5 sludge (n ¼ 9) than grade 1 and 2 (n ¼ 11) when
compared to the rest of the study population (odds ratio 5.04; CI:
1.90–13.33; P , 0.002%).
Fifteen dogs had received exogenous glucocorticoids for .4
wk prior to examination. Agents administered included prednisone
(n ¼ 13; median dose 1.1 mg/kg/d; range 0.2–2.2 mg/kg/d),
dexamethasone (n ¼ 1; 0.16 mg/kg), and budesonide (n ¼ 1; 0.15
mg/kg). The administration of exogenous steroids for .4 wk was
not associated with increased sludge.

Discussion
Echogenic luminal contents were noted in two-thirds of canine
patients undergoing routine diagnostic US examination of the
abdomen at this institution. This is substantially higher than the
prevalence reported in a recent study from Brazil, in which sludge
was reported in 35% of 1021 dogs undergoing abdominal US
evaluation.16 This may reflect different patient demographics or
other characteristics. Certainly, animals examined at our institution
may not reliably reflect the canine population in general, and
conclusions regarding the true prevalence of sludge in this species
should be made with caution. It is interesting to note that four dogs
(2% of those examined) had US evidence of a MC. This number is
higher than expected and does suggest that findings from a tertiary
referral center are subject to substantial bias.
In this report, dogs with .75% hyperechoic bile and those
with US findings indicating a MC were classified separately. In fact,
the diagnosis of a MC requires documentation of mucinous
hyperplasia of the GB epithelium and cannot be definitively
determined on the basis of US or gross findings alone.17 However,
the majority of canine GB MCs have such a distinctive US
appearance that this imaging modality is considered to be highly
specific for this condition.1,2 Although it is possible that some of
these eight patients were incorrectly categorized, it was important
to attempt to separate dogs with severe sludge (.75%) from those
with a MC. Failure to separate these patients would have implied
some commonality between these two conditions and may have
biased our results.
Overall, dogs with grade 3–5 sludge had larger GB volumes
(indexed for body weight) compared to those with grade 1 and 2
sludge. Since compromised GB emptying has been associated with
microlithiasis in people, this is the most likely explanation for this
finding in this patient population.5 GB emptying is triggered by the
arrival of ingesta in the proximal small intestine and is mediated by
cholecystokinin. Impaired emptying may reflect a derangement in
the normal signaling process or an inability to effectively move
abnormally dense contents. Prospective, dynamic studies using
timed meals or cholecystokinin analogues are needed to investigate
potential associations between GB sludge and emptying in dogs.
In common with previous veterinary studies, our findings
indicate that biliary sludge is more likely to be noted in older
dogs.9,16 However, the development of sludge cannot be predicted
simply on the basis of advancing age, as there was no evidence of a
linear relationship between these parameters, and several dogs with
uniformly hypoechoic bile were .10 yr of age. The development of
biliary sludge in people is thought to be multifactorial, but
Gallbladder Sludge in Dogs
increasing age is consistently identified as a strong risk factor. In
fact, the incidence of gallstones increases 4–10-fold after age 40.5
Obesity and insulin resistance are commonly implicated in
human microlithiasis. In our patient population, the median BCS
for dogs with grade 1 and 2 sludge was not significantly different
from those graded 3–5. Unfortunately, BCS was not available for
.2/3 of dogs, which limited statistical power. It is interesting to
note that none of the dogs graded 3–5 were judged to be
underweight (i.e., BCS 4).
All of the serum biochemical parameters evaluated (i.e.,
cholesterol, bilirubin, ALP, and GGT) were not apparently
influenced by the extent of biliary sludging. As both ALP and
GGT activity indicate cholestatic processes within the liver and
biliary tree, it seems unlikely that sludge formation is necessarily
related to compromised bile flow.18 Hypercholesterolemia is
strongly associated with biliary sludging and cholelithiasis in
people, and cholesterol is a primary constituent of human biliary
sludge.5 The fact that serum cholesterol concentrations were not
related to sludge severity in our patient population concurs with
the findings of a similar study and supports the hypothesis that
cholesterol is unlikely to be a major component of canine biliary
sludge.16
Biliary sludge has been induced in dogs by cystic duct ligation
or through dietary manipulation.6,7 In both models, the sludge
consisted primarily of bilirubinate and mucin, variably complexed
with calcium carbonate. As this material coalesced into pigmentary
gallstones, it may have limited similarities to spontaneous sludge.
GB contents were analyzed in one Shetland sheepdog with a MC;
the material was shown to have a similar composition to the
experimentally induced sludge.19 However, as this breed has a
strong genetic predisposition for defective phoshatidylcholine
secretion and subsequent MC formation, this finding may not
reliably reflect events in other breeds.11
Both HAC and HT have been identified as a risk factor for MC
formation in dogs.12 In our study, the presence of HAC or HT was
significantly associated with substantial GB sludge (odds ratio
5.04). This finding suggests a link between biliary sludge and the
development of a MC. Various sources have proposed that the two
are interconnected and that substantial sludge precedes the
generation of a MC. This has not been proven, although sludge
has been reported around or embedded within MCs.13 In
experimental studies, glucocorticoids have been shown to alter
bile acid profiles in dogs, with a shift towards the more irritant
hydrophobic forms.20 This change may impact GB epithelial
function and mucus production. Subnormal thyroid levels have
been associated with delayed emptying of bile into the intestine in
people, and it has been suggested that chronic bile stasis may lead
JAAHA.ORG 129
to the formation of sludge and excessive mucus secretion.21
Although 16 dogs in this study population were classified as HT,
there was inadequate information regarding the initial diagnosis
and the duration and efficacy of supplementation. One clinical
report suggests that effective thyroid supplementation may result in
a resolution of GB MC, but its impact on sludge has not been
described in dogs.13 Prospective studies looking at GB contents at
the time of diagnosis and following treatment are needed.
In this patient population, the administration of exogenous
glucocorticoids for at least 4 wk did not appear to impact the
formation of sludge. However, this finding may reflect a relatively
short duration of administration in some dogs and substantial
variation in glucocorticoid dosing. A recent study of dogs receiving
high doses of exogenous glucocorticoids for 3 mo reported that all
treated dogs (n ¼ 6) developed GB sludge.8 However, this was not
significantly different to the control group (n ¼ 6), half of which
also developed sludge over the same time period. Further work is
needed to assess the impact of prolonged administration of
exogenous glucocorticoids on GB status in dogs.
Although this study provides some useful insight into canine
biliary sludge, it has several limitations. As this was an
observational study, and not a prospective one, variables such
as duration of fasting and administration of sedation prior to US
evaluation could not be controlled. Sedation did not appear to
impact US findings (% sludge, GB volume) in this patient
population, but recent feeding may certainly influence these
parameters. In addition, several radiologists participated in the
grading process and may not have been consistent with their
assessments. Conclusions regarding GB volume must be made
cautiously, as volumes were estimated used a modification of a
reported formula, the reliability of which has not been
established.
For statistical purposes, dogs with .25% sludge (grades 3, 4,
and 5) were considered together. This was necessary because of
small group sizes but may have limited our ability to detect
differences between groups regarding the biochemical parameters
assessed. Larger studies may be needed to identify associations
between routine clinicopathologic data and GB sludge in dogs.
One of the major limitations to our understanding of canine
GB sludge is a lack of information regarding its composition. It is
possible that different biochemical constituents are present in
various dogs and may reflect varying etiologies. Additional
prospective longitudinal studies with larger patient numbers are
needed to establish the clinical impact of biliary sludge in dogs. In
particular, the relationship (if any) between sludge and the
development of the GB MC needs further investigation.
130 JAAHA | 52:3 May/Jun 2016
Conclusion
This study suggests that echogenic liminal material is routinely
noted within the GB of dogs during transabdominal US
examination at a veterinary teaching hospital, with echogenic
contents reported in two-thirds of patients. Sludge formation was
associated with increasing patient age but was not apparently
influenced by patient weight or obesity. Dogs with clinical evidence
of hepatobiliary disease were more likely to have hyperechoic GB
contents than the general population, but the presence of
substantial sludge was not associated with routine biochemical
markers of biliary status (i.e., serum cholesterol and bilirubin
concentrations; serum ALP or GGT activities). Similar to reports of
dogs with MCs, biliary sludge was strongly associated with
spontaneous HAC. Abnormal emptying was suggested by increased
median GB volume in dogs with .25% sludge. Further studies are
needed to determine the indications for intervention in dogs with
biliary sludge and its possible connection to MC formation or other
biliary tract disorders.
FOOTNOTES
a
Acuson Sequoia 512; Siemens Medical Solutions USA Inc., Mountain
View, CA
b
Acuson Antares; Siemens Medical Solutions USA Inc., Mountain View,
CA
c
Vitros 250; Ortho-Clinical Diagnostics, Rochester, NY
d
GraphPad Prism Version 5.01; GraphPad Software Inc., La Jolla, CA
REFERENCES
1. Crews LJ, Feeney DA, Jessen CR, et al. Clinical, ultrasonographic, and
laboratory findings associated with gallbladder disease and rupture in
dogs: 45 cases (1997-2007). J Am Vet Med Assoc 2009;234:359–366.
2. Besso JG, Wrigley RH, Gilatto JM, et al. Ultrasonographic appearance
and clinical findings in 14 dogs with gallbladder mucocele. Vet Radiol
Ultrasoun 2000;41:261–271.
3. Ko CE, Schulte SK, Lee SP. Biliary sludge is formed by modification of
hepatic bile by the gallbladder mucosa. Clin Gastroenterol Hepatol
2005;3:672–678.
4. Jungst C, Kullak-Ublick GA, Jungst D. Microlithiasis and sludge. Best
Pract Res Clin Ga 2006;20:1053–1062.
5. Stinton LM, Shafer EA. Epidemiology of Gallbladder Disease:
Cholelithiasis and Cancer Gut Liver 2012;6:172–187.
6. Bernhoft RA, Pelligrini CA, Broderick WC, et al. Pigment sludge and
stone formation in the acutely ligated dog gallbladder. Gastroenterol
1983;85:1166–1171.
7. Dawes LG, Nahrwold DL, Rege RV. Supersaturation of canine
gallbladder bile with calcium bilirubinate during formation of pigment
gallstones. Am J Surg 1989;157:82–88.
8. Kook PK, Schellenberg S, Rentsch KM, et al. Effects of iatrogenic
hypercortisolism on gallbladder sludge formation and biochemical bile
constituents in dogs. Vet J 2012;191:225–230.
9. Bromel C, Barthez PY, Leveille R, et al. Prevalence of gallbladder sludge
in dogs as assessed by ultrasonography. Vet Radiol Ultrasoun 1998;39:
206–221.

10. Tsukagoshi T. Ohno K, Tsukamoto A, et al. Decreased gallbladder
emptying in dogs with biliary sludge or gallbladder mucocele. Vet
Radiol Ultrasoun 2012;53:84–91.
11. Mealey KL, Minch JD, White SN, et al. An insertion mutation in
ABCB4 is associated with gallbladder mucocele formation in dogs.
Comp Hepatol 2010;9:6.
12. Mesich MLL, Mayhew PD, Paek M, et al. Gall bladder mucoceles and
their association with endocrinopathies in dogs: a retrospective case-
control study. J Sm Anim Pract 2009;50:630–635.
13. Walter R, Dunn ME, d’Anjou MA, et al. Nonsurgical resolution of
gallbladder mucocele in two dogs. J Am Vet Med Assoc 2008;232:1688–
1693.
14. Mehler SJ, Mayhew PD, Drobatz KJ, et al. Variable associated with
outcome in dogs undergoing extrahepatic biliary surgery: 60 cases. Vet
Surg 2004;33:644–649.
Gallbladder Sludge in Dogs
15. Dodds WJ, Groh WJ, Darweesh RM, et al. Sonographic measurement of
gallbladder volume. Am J Roentgenol 1985;145:1009–1011.
16. Secchi P, Poppi AG, Ilha A, et al. Prevalence, risk factors, and
biochemical markers in dogs with ultrasound-diagnosed biliary sludge.
Res Vet Sci 2012;93:1185–1189.
17. Pike FS, Berg J, King NW, et al. Gallbladder mucocele in dogs: 30 cases
(2000-2002). J Am Vet Med Assoc 2004;224:1615–1622.
18. Center SA. Interpretation of liver enzymes. Vet Clin N Am-Small 2007;
37:297–333.
19. Aguirre AL, Center SA, Randolph JF. Gallbladder disease in Shetland
sheepdogs: 38 cases (1995-2005). J Am Vet Med Assoc 2007;231:79–88.
20. Kook PK, Schellenberg S, Rentsch KM, et al. Effect of twice-daily oral
administration of hydrocortisone on the bile acids composition of
gallbladder bile in dogs. Am J Vet Res 2001;72:1607–1612.
21. Laukkarinen J, Sand J, Saaristo R, et al. Is bile flow reduced in patients
with hypothyroidism? Surgery 2003;133:288–293.
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